Gotham GazetteGotham Gazette is an online publication covering New York policy and politics as well as news on public safety, transportation, education, finance and more.http://www.gothamgazette.com/component/tags/tag/health-care2017-12-14T00:21:44+00:00Webmasterwebmaster@gothamgazette.comAmid Health Care Funding Fights, Cuomo Explores Special Session2017-10-11T04:00:00+00:002017-10-11T04:00:00+00:00http://www.gothamgazette.com/?id=7244:amid-health-care-funding-feud-cuomo-explores-special-sessionBen Max<p><img src="http://www.gothamgazette.com/images/graphics/2017/andrew-cuomo.jpg" alt="andrew cuomo" width="600" height="381" /></p>
<p>Gov.&nbsp;Cuomo with top health and budget aides (photo: Kevin P. Coughlin/Governor's Office)</p>
<hr />
<p>Governor Andrew Cuomo has been floating the idea of a special legislative session to address federal cuts to the state’s health care programs, as well as other concerns that have developed, since the state budget was agreed to in April.</p>
<p>In that budget, Cuomo pushed to include and won a provision granting him nearly unilateral power to adjust the state’s financial plan mid-year in the event of at least $800 million in federal cuts to the state. In April, the governor said the provision would ensure that “we do not overcommit ourselves financially” and indicated it allowed him to sign off on a budget that did not otherwise account for likely federal cuts. But, it appears as if Cuomo may call lawmakers back to Albany -- likely with agreement from the legislative majorities to an agenda -- regardless of whether the threshold has been met.</p>
<p>When the state Legislature finished its legislative year in June with <a href="http://www.gothamgazette.com/state/7042-mayoral-control-extended-in-special-session-with-usual-albany-process" target="_blank" rel="noopener noreferrer">a brief special session</a> to pass mayoral control of schools as well as several smaller measures, such as $55 million in state aid for businesses and homeowners impacted by flooding around Lake Ontario, unknowns surrounding President Donald Trump’s promise to “repeal and replace Obamacare” loomed large.</p>
<p>As chatter of a special session to address two lapsed federally subsidized health care programs escalated this week, so did a feud between Cuomo’s administration and that of New York City Mayor Bill de Blasio over $380 million that was earmarked to reimburse New York City Health + Hospitals, the city’s public hospital network, for expenses incurred treating uninsured and indigent patients over the last two years.</p>
<p>In recent weeks, Cuomo has sounded the alarm over four essential funding streams to New York health care systems that are being threatened by Trump and a Republican-led Congress. While the federal Graham-Cassidy bill -- a replacement to the Affordable Care Act that would have cost New York $16.9 billion by 2025, according to projections -- was defeated, and parts of Trump’s sweeping tax plan that target blue states are on shaky ground, the federal government failed to renew the Disproportionate Share Hospitals funds, known as D.S.H., by October 1, creating a potential $2.6 billion shortfall that is expected to disproportionately hit New York City’s public hospital system over the next year and a half.</p>
<p>If they remain in effect, the cuts will place a $330,000 burden on Health + Hospitals for federal fiscal year 2018, but the city says the state is also unlawfully holding $380 million in federal funds owed to city hospitals for federal fiscal year 2017, which just ended, for services already provided.</p>
<p>This federal funding, which passes through the state, is allocated for municipal and state-run hospitals that treat high volumes of uninsured and indigent patients.</p>
<p>While it is unclear whether the cut would justify a budget adjustment by the executive branch given the April budget provision, Cuomo appears to be courting lawmakers to return for a special session that could address D.S.H. and other looming health care deficits.</p>
<p>Also lapsing earlier this month is the federal Child Health Insurance Plan (CHIP), which subsidizes New York’s Child Health Plus plan, putting New York in a $1.1 billion hole and potentially jeopardizing the health coverage of 330,000 lower-income New York children, according to Cuomo’s office, though it seems likely a federal deal over the children’s health program may soon be reached. Still, the state has been placed in a precarious position.</p>
<p>In <a href="https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/DOHLettertoActingSecretaryWright.pdf" target="_blank" rel="noopener noreferrer">a letter</a> sent Wednesday to Eric Hargan, acting secretary of the U.S. Department of Health and Human Services, New York State Health Commissioner Howard Zucker warned that New York will not be able to continue the current Child Health Plus program if Congress fails to renew $1 billion in federal funding, and he said that Governor Andrew M. Cuomo will “have no choice but to call a special session of the Legislature.”</p>
<p>On Tuesday, Cuomo had dangled the special session idea before 13 upstate lawmakers, and in reality a much wider audience, suggesting in <a href="https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/GAMC_Letter.pdf" target="_blank" rel="noopener noreferrer">a letter</a> that an extraordinary legislative session could also be used to amplify and speed up relief funding for Lake Ontario flood victims.</p>
<p>“I would support a special session of the legislature to return and appropriate an additional $35 million for this program to fund all eligible applicants in a time frame that recognizes the urgency of the situation,” Cuomo wrote. “There are other pending issues that could also be addressed at a special session, including the financial hardship the State will face from potential federal cutbacks.”</p>
<p>In addition to the 11 public hospitals in New York City’s Health + Hospitals system, the D.S.H. cuts directly impact the state-run SUNY Upstate Medical Center in Syracuse and SUNY Downstate hospitals in Brooklyn, Westchester County Medical Center, Nassau University Medical Center and Erie County Medical Center.</p>
<p>None of these facilities will receive payments until adjustments are made, according to Cuomo’s office.</p>
<p>The state has retained an outside consultant, KPMG, to figure out how to help health care facilities manage the cuts and Cuomo has repeatedly suggested that the Legislature may be forced to reconvene Congress signals that the money will not be restored by December 31. In a press conference on the topic last Tuesday, the governor suggested that local governments step up to offset some of the cuts.</p>
<p>“Nassau needs to help their public hospitals, New York City -- with a $4 billion surplus -- needs to help H+H, and SUNY will need to help Downstate and Upstate hospitals,” he said.</p>
<p>The cuts and Cuomo’s approach to dealing with them have ignited another episode in the feud between the governor and de Blasio and on Friday, the&nbsp;de Blasio administration announced its intention to sue New York State for D.S.H funds which administration officials say were expected by the city’s cash-strapped public hospital system for the federal fiscal year that ended on September 30.</p>
<p>City officials say they had budgeted with the expectation that $380 million would come through and Health + Hospitals Interim President and CEO Stan Brezenoff revealed that that the hospital system had begun to cut back on hiring to account for the deficit and was prepared to take other undesirable and risky measures.</p>
<p>“Our ability to deliver on our mission also relies on all levels of government. Unfortunately, the State is showing a shocking disregard for our mission and appears to have confirmed in public statements that they will not be releasing the $380 million Disproportionate Share Hospitals (DSH) funds that we need and deserve for serving more than one million Medicaid, uninsured and immigrant New Yorkers who relied on our care last fiscal year,” Brezenoff wrote in a letter to staff members last week.</p>
<p>As of Tuesday night, a spokesperson for the mayor’s office said the lawsuit would be filed “in state court,” but could say when it would be filed, or who would be named in the suit.&nbsp;De Blasio himself has&nbsp;<a href="http://www.politico.com/states/new-york/albany/story/2017/10/03/de-blasio-says-no-excuse-for-cuomos-holding-onto-dsh-funds-114845" target="_blank" rel="noopener noreferrer">said</a>&nbsp;that the state’s withholding of past D.S.H payments designated for H+H, "is not normal and there is no excuse for it.”</p>
<p>Cuomo’s administration maintains that it is withholding its final payment to New York City’s public hospitals for the 2017 cycle in September because it is still unclear whether the federal government will renew the D.S.H. program.</p>
<p>“There’s no way to fund the public hospitals with a $1.1 billion cut unless it is rolled back,” the governor said during a press briefing last week. “In the meantime, we have made no D.S.H. payments to any public hospitals since October 1, which is when the law went into effect. You can’t distribute funding until you know how much you have to distribute.”</p>
<p>Cuomo officials say city hospitals should have anticipated the cut, noting that the program, which is associated with the Affordable Care Act, was always intended to be phased out as more New Yorkers became insured.</p>
<p>“The federal cuts to DSH have been pending for seven years and we are sure that all responsible CEOs of the state’s public hospitals have been accounting for these potential shortfalls in that time,” said Jason Helgerson, New York State Medicaid Director, in a statement. “The suggestion that the state is somehow in a position to reverse federal cuts is willful political ignorance and a distortion of reality -- only the federal government can possibly restore cuts they’ve enacted. Save for the federal government restoring these funds, there is no way the remaining DSH dollars can reimburse all hospitals at 100 percent.”</p>
<p>Cuomo’s office says that it has been in contact with city hospital officials and shared a letter Helgerson sent Brezenoff on September 29, referencing a meeting of healthcare providers to discuss the potentially imminent demise of D.S.H.</p>
<p>“While we implored Congress to act, as the October 1 deadline approaches, it is clear&nbsp;they are failing to do so,” the state Medicaid director wrote. “The Governor convened health care providers on September 19 to discuss the possibility of these cuts and held a press conference with the group outlining how harmful they will be.”</p>
<p>City officials claim that they have been singled out, and that all the state-run public hospitals have received their payments for the past fiscal year.</p>
<p>Regarding the potential lawsuit from New York City, Cuomo spokesperson Dani Lever called the threat “political theatre.”</p>
<p>“A more productive action would be to sue the federal government since they are making these devastating cuts, or if it actually cared about patient care, to use its funds to improve the hospital network that it owns,” said Lever.</p>
<p>One strategy -- requiring a legislative fix enacted through a special session -- would be to disperse the initial $380 million burden across hospitals throughout the state, most of which do not treat a large number of uninsured patients, state budget director Robert Mujica said in <a href="http://www.ny1.com/nyc/all-boroughs/inside-city-hall/2017/10/06/city-vs--state-in-hospital-fight--the-state-side" target="_blank" rel="noopener noreferrer">an interview with NY1</a> last week.</p>
<p>“The way the federal law interacts with the state law presently, is the first year of the cuts really impacts H+H first, under the law,” said Mujica. “So does that mean trying spreading the pain across all of the hospitals? That’s something we really have to look at. But always, redistributing is going to be very challenging. We hope it doesn’t come to that. We hope that the feds restore restore the cuts.”</p>
<p>U.S. Senate Democratic Leader Chuck Schumer of New York, who <a href="http://www.nystateofpolitics.com/2017/09/schumer-reed-say-theyll-do-their-best-to-fight-medicaid-dsh-cuts/" target="_blank" rel="noopener noreferrer">told State of Politics</a> he’s been leading the charge to restore the hospital funding, described the battle in Congress as “neck-and-neck.”</p>
<p>The expiration of CHIP appears less dire; while the funding ended on September 30, states will not run out of the money for several months, and protecting children’s health is an issue that has bipartisan appeal. Schumer, who has been pushing to attach the renewal of CHIP funding to an Obamacare fix intended to stabilize markets and lower premiums, <a href="http://thehill.com/policy/healthcare/353852-schumer-calls-for-attaching-obamacare-fix-to-childrens-health-insurance" target="_blank" rel="noopener noreferrer">said</a> he is working with his Republican colleagues to find a way to pay for the program.</p>
<p>About one-third of patients at the city’s public hospitals are uninsured and the network currently receives the largest D.S.H share. However, divvied up across state health care institutions, the $380 million burden would only account for less 1 percent of all hospital revenue, according to Bill Hammond, director of health policy at the Empire Center for Public Policy, a think tank.</p>
<p>"The lost money, if you look at just the federal losses, it’s about $330 million and that grows to $500 million in the second year, so it grows more and more every year. Spread across all the hospitals it would not be such a big deal, but right now it’s concentrated among 11 H+H hospitals, which is a problem,” Hammond said.</p>
<p>The ongoing federal health care crisis has also breathed new life into <a href="http://cityandstateny.com/articles/personality/interviews-and-profiles/new-york-health-care-debate.html#.Wd549WJSw6U" target="_blank" rel="noopener noreferrer">the debate</a> over whether New York State would be well-served by a single-payer healthcare system, which Cuomo recently signalled tepid support for in an interview <a href="http://www.wnyc.org/story/governor-cuomo-talks-daca-and-hurricane-irma-damage-mayor-de-blasio/" target="_blank" rel="noopener noreferrer">with WNYC radio’s Brian Lehrer.</a></p>
<p>A state-level universal health care bill, which guarantees health coverage to all New Yorkers regardless of ability to pay or immigration status, has repeatedly passed the Democratically-controlled Assembly, but has been defeated in the Republican-led state Senate by a sliver of a margin.</p>
<p>Assemblymember Dick Gottfried of Manhattan, who sponsors the bill, acknowledged that even if a version of his legislation was enacted tomorrow, it would take several years to fully implement, but said it warranted a second look given the uncertainty coming from Washington.</p>
<p>"It would not provide immediate relief, but the cuts that are likely to come from Washington will not come all at once, they will like snowball over the next couple of years," said Gottfried. “If we recognize health care as a right and provide health care coverage to every single New Yorker…Under a single-payer system, safety net hospitals and public hospitals would make out much better than they do today.”</p>
<p>Hospitals would save millions of dollars in administrative costs and the state would be in a much better position to bargain with drug companies, as it would represent 20 million patients, Gottfried added.</p>
<p>“Those savings are about the only way, realistically, that we can fill the gaps from whatever federal cuts are coming, without significantly damaging other programs or raising taxes,” he said. Critics, <a href="http://www.nydailynews.com/opinion/bill-hammond-n-y-s-preposterous-single-payer-fantasy-article-1.2694958" target="_blank" rel="noopener noreferrer">including Hammond</a>, have said that Gottfried’s single-payer plan would be far costlier to the state that the Assembly member suggests.</p>
<p>When reached for comment on the health care cuts and whether the Assembly is prepared to return to Albany to deal with the situation, Mike Whyland, spokesperson for Assembly Speaker Carl Heastie, said, “We care deeply about these hospitals and are closely monitoring it.”</p>
<p>A spokesperson for Senate Majority Leader John Flanagan did not respond to a request for comment.&nbsp;</p>
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</p><p><img src="http://www.gothamgazette.com/images/graphics/2017/andrew-cuomo.jpg" alt="andrew cuomo" width="600" height="381" /></p>
<p>Gov.&nbsp;Cuomo with top health and budget aides (photo: Kevin P. Coughlin/Governor's Office)</p>
<hr />
<p>Governor Andrew Cuomo has been floating the idea of a special legislative session to address federal cuts to the state’s health care programs, as well as other concerns that have developed, since the state budget was agreed to in April.</p>
<p>In that budget, Cuomo pushed to include and won a provision granting him nearly unilateral power to adjust the state’s financial plan mid-year in the event of at least $800 million in federal cuts to the state. In April, the governor said the provision would ensure that “we do not overcommit ourselves financially” and indicated it allowed him to sign off on a budget that did not otherwise account for likely federal cuts. But, it appears as if Cuomo may call lawmakers back to Albany -- likely with agreement from the legislative majorities to an agenda -- regardless of whether the threshold has been met.</p>
<p>When the state Legislature finished its legislative year in June with <a href="http://www.gothamgazette.com/state/7042-mayoral-control-extended-in-special-session-with-usual-albany-process" target="_blank" rel="noopener noreferrer">a brief special session</a> to pass mayoral control of schools as well as several smaller measures, such as $55 million in state aid for businesses and homeowners impacted by flooding around Lake Ontario, unknowns surrounding President Donald Trump’s promise to “repeal and replace Obamacare” loomed large.</p>
<p>As chatter of a special session to address two lapsed federally subsidized health care programs escalated this week, so did a feud between Cuomo’s administration and that of New York City Mayor Bill de Blasio over $380 million that was earmarked to reimburse New York City Health + Hospitals, the city’s public hospital network, for expenses incurred treating uninsured and indigent patients over the last two years.</p>
<p>In recent weeks, Cuomo has sounded the alarm over four essential funding streams to New York health care systems that are being threatened by Trump and a Republican-led Congress. While the federal Graham-Cassidy bill -- a replacement to the Affordable Care Act that would have cost New York $16.9 billion by 2025, according to projections -- was defeated, and parts of Trump’s sweeping tax plan that target blue states are on shaky ground, the federal government failed to renew the Disproportionate Share Hospitals funds, known as D.S.H., by October 1, creating a potential $2.6 billion shortfall that is expected to disproportionately hit New York City’s public hospital system over the next year and a half.</p>
<p>If they remain in effect, the cuts will place a $330,000 burden on Health + Hospitals for federal fiscal year 2018, but the city says the state is also unlawfully holding $380 million in federal funds owed to city hospitals for federal fiscal year 2017, which just ended, for services already provided.</p>
<p>This federal funding, which passes through the state, is allocated for municipal and state-run hospitals that treat high volumes of uninsured and indigent patients.</p>
<p>While it is unclear whether the cut would justify a budget adjustment by the executive branch given the April budget provision, Cuomo appears to be courting lawmakers to return for a special session that could address D.S.H. and other looming health care deficits.</p>
<p>Also lapsing earlier this month is the federal Child Health Insurance Plan (CHIP), which subsidizes New York’s Child Health Plus plan, putting New York in a $1.1 billion hole and potentially jeopardizing the health coverage of 330,000 lower-income New York children, according to Cuomo’s office, though it seems likely a federal deal over the children’s health program may soon be reached. Still, the state has been placed in a precarious position.</p>
<p>In <a href="https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/DOHLettertoActingSecretaryWright.pdf" target="_blank" rel="noopener noreferrer">a letter</a> sent Wednesday to Eric Hargan, acting secretary of the U.S. Department of Health and Human Services, New York State Health Commissioner Howard Zucker warned that New York will not be able to continue the current Child Health Plus program if Congress fails to renew $1 billion in federal funding, and he said that Governor Andrew M. Cuomo will “have no choice but to call a special session of the Legislature.”</p>
<p>On Tuesday, Cuomo had dangled the special session idea before 13 upstate lawmakers, and in reality a much wider audience, suggesting in <a href="https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/GAMC_Letter.pdf" target="_blank" rel="noopener noreferrer">a letter</a> that an extraordinary legislative session could also be used to amplify and speed up relief funding for Lake Ontario flood victims.</p>
<p>“I would support a special session of the legislature to return and appropriate an additional $35 million for this program to fund all eligible applicants in a time frame that recognizes the urgency of the situation,” Cuomo wrote. “There are other pending issues that could also be addressed at a special session, including the financial hardship the State will face from potential federal cutbacks.”</p>
<p>In addition to the 11 public hospitals in New York City’s Health + Hospitals system, the D.S.H. cuts directly impact the state-run SUNY Upstate Medical Center in Syracuse and SUNY Downstate hospitals in Brooklyn, Westchester County Medical Center, Nassau University Medical Center and Erie County Medical Center.</p>
<p>None of these facilities will receive payments until adjustments are made, according to Cuomo’s office.</p>
<p>The state has retained an outside consultant, KPMG, to figure out how to help health care facilities manage the cuts and Cuomo has repeatedly suggested that the Legislature may be forced to reconvene Congress signals that the money will not be restored by December 31. In a press conference on the topic last Tuesday, the governor suggested that local governments step up to offset some of the cuts.</p>
<p>“Nassau needs to help their public hospitals, New York City -- with a $4 billion surplus -- needs to help H+H, and SUNY will need to help Downstate and Upstate hospitals,” he said.</p>
<p>The cuts and Cuomo’s approach to dealing with them have ignited another episode in the feud between the governor and de Blasio and on Friday, the&nbsp;de Blasio administration announced its intention to sue New York State for D.S.H funds which administration officials say were expected by the city’s cash-strapped public hospital system for the federal fiscal year that ended on September 30.</p>
<p>City officials say they had budgeted with the expectation that $380 million would come through and Health + Hospitals Interim President and CEO Stan Brezenoff revealed that that the hospital system had begun to cut back on hiring to account for the deficit and was prepared to take other undesirable and risky measures.</p>
<p>“Our ability to deliver on our mission also relies on all levels of government. Unfortunately, the State is showing a shocking disregard for our mission and appears to have confirmed in public statements that they will not be releasing the $380 million Disproportionate Share Hospitals (DSH) funds that we need and deserve for serving more than one million Medicaid, uninsured and immigrant New Yorkers who relied on our care last fiscal year,” Brezenoff wrote in a letter to staff members last week.</p>
<p>As of Tuesday night, a spokesperson for the mayor’s office said the lawsuit would be filed “in state court,” but could say when it would be filed, or who would be named in the suit.&nbsp;De Blasio himself has&nbsp;<a href="http://www.politico.com/states/new-york/albany/story/2017/10/03/de-blasio-says-no-excuse-for-cuomos-holding-onto-dsh-funds-114845" target="_blank" rel="noopener noreferrer">said</a>&nbsp;that the state’s withholding of past D.S.H payments designated for H+H, "is not normal and there is no excuse for it.”</p>
<p>Cuomo’s administration maintains that it is withholding its final payment to New York City’s public hospitals for the 2017 cycle in September because it is still unclear whether the federal government will renew the D.S.H. program.</p>
<p>“There’s no way to fund the public hospitals with a $1.1 billion cut unless it is rolled back,” the governor said during a press briefing last week. “In the meantime, we have made no D.S.H. payments to any public hospitals since October 1, which is when the law went into effect. You can’t distribute funding until you know how much you have to distribute.”</p>
<p>Cuomo officials say city hospitals should have anticipated the cut, noting that the program, which is associated with the Affordable Care Act, was always intended to be phased out as more New Yorkers became insured.</p>
<p>“The federal cuts to DSH have been pending for seven years and we are sure that all responsible CEOs of the state’s public hospitals have been accounting for these potential shortfalls in that time,” said Jason Helgerson, New York State Medicaid Director, in a statement. “The suggestion that the state is somehow in a position to reverse federal cuts is willful political ignorance and a distortion of reality -- only the federal government can possibly restore cuts they’ve enacted. Save for the federal government restoring these funds, there is no way the remaining DSH dollars can reimburse all hospitals at 100 percent.”</p>
<p>Cuomo’s office says that it has been in contact with city hospital officials and shared a letter Helgerson sent Brezenoff on September 29, referencing a meeting of healthcare providers to discuss the potentially imminent demise of D.S.H.</p>
<p>“While we implored Congress to act, as the October 1 deadline approaches, it is clear&nbsp;they are failing to do so,” the state Medicaid director wrote. “The Governor convened health care providers on September 19 to discuss the possibility of these cuts and held a press conference with the group outlining how harmful they will be.”</p>
<p>City officials claim that they have been singled out, and that all the state-run public hospitals have received their payments for the past fiscal year.</p>
<p>Regarding the potential lawsuit from New York City, Cuomo spokesperson Dani Lever called the threat “political theatre.”</p>
<p>“A more productive action would be to sue the federal government since they are making these devastating cuts, or if it actually cared about patient care, to use its funds to improve the hospital network that it owns,” said Lever.</p>
<p>One strategy -- requiring a legislative fix enacted through a special session -- would be to disperse the initial $380 million burden across hospitals throughout the state, most of which do not treat a large number of uninsured patients, state budget director Robert Mujica said in <a href="http://www.ny1.com/nyc/all-boroughs/inside-city-hall/2017/10/06/city-vs--state-in-hospital-fight--the-state-side" target="_blank" rel="noopener noreferrer">an interview with NY1</a> last week.</p>
<p>“The way the federal law interacts with the state law presently, is the first year of the cuts really impacts H+H first, under the law,” said Mujica. “So does that mean trying spreading the pain across all of the hospitals? That’s something we really have to look at. But always, redistributing is going to be very challenging. We hope it doesn’t come to that. We hope that the feds restore restore the cuts.”</p>
<p>U.S. Senate Democratic Leader Chuck Schumer of New York, who <a href="http://www.nystateofpolitics.com/2017/09/schumer-reed-say-theyll-do-their-best-to-fight-medicaid-dsh-cuts/" target="_blank" rel="noopener noreferrer">told State of Politics</a> he’s been leading the charge to restore the hospital funding, described the battle in Congress as “neck-and-neck.”</p>
<p>The expiration of CHIP appears less dire; while the funding ended on September 30, states will not run out of the money for several months, and protecting children’s health is an issue that has bipartisan appeal. Schumer, who has been pushing to attach the renewal of CHIP funding to an Obamacare fix intended to stabilize markets and lower premiums, <a href="http://thehill.com/policy/healthcare/353852-schumer-calls-for-attaching-obamacare-fix-to-childrens-health-insurance" target="_blank" rel="noopener noreferrer">said</a> he is working with his Republican colleagues to find a way to pay for the program.</p>
<p>About one-third of patients at the city’s public hospitals are uninsured and the network currently receives the largest D.S.H share. However, divvied up across state health care institutions, the $380 million burden would only account for less 1 percent of all hospital revenue, according to Bill Hammond, director of health policy at the Empire Center for Public Policy, a think tank.</p>
<p>"The lost money, if you look at just the federal losses, it’s about $330 million and that grows to $500 million in the second year, so it grows more and more every year. Spread across all the hospitals it would not be such a big deal, but right now it’s concentrated among 11 H+H hospitals, which is a problem,” Hammond said.</p>
<p>The ongoing federal health care crisis has also breathed new life into <a href="http://cityandstateny.com/articles/personality/interviews-and-profiles/new-york-health-care-debate.html#.Wd549WJSw6U" target="_blank" rel="noopener noreferrer">the debate</a> over whether New York State would be well-served by a single-payer healthcare system, which Cuomo recently signalled tepid support for in an interview <a href="http://www.wnyc.org/story/governor-cuomo-talks-daca-and-hurricane-irma-damage-mayor-de-blasio/" target="_blank" rel="noopener noreferrer">with WNYC radio’s Brian Lehrer.</a></p>
<p>A state-level universal health care bill, which guarantees health coverage to all New Yorkers regardless of ability to pay or immigration status, has repeatedly passed the Democratically-controlled Assembly, but has been defeated in the Republican-led state Senate by a sliver of a margin.</p>
<p>Assemblymember Dick Gottfried of Manhattan, who sponsors the bill, acknowledged that even if a version of his legislation was enacted tomorrow, it would take several years to fully implement, but said it warranted a second look given the uncertainty coming from Washington.</p>
<p>"It would not provide immediate relief, but the cuts that are likely to come from Washington will not come all at once, they will like snowball over the next couple of years," said Gottfried. “If we recognize health care as a right and provide health care coverage to every single New Yorker…Under a single-payer system, safety net hospitals and public hospitals would make out much better than they do today.”</p>
<p>Hospitals would save millions of dollars in administrative costs and the state would be in a much better position to bargain with drug companies, as it would represent 20 million patients, Gottfried added.</p>
<p>“Those savings are about the only way, realistically, that we can fill the gaps from whatever federal cuts are coming, without significantly damaging other programs or raising taxes,” he said. Critics, <a href="http://www.nydailynews.com/opinion/bill-hammond-n-y-s-preposterous-single-payer-fantasy-article-1.2694958" target="_blank" rel="noopener noreferrer">including Hammond</a>, have said that Gottfried’s single-payer plan would be far costlier to the state that the Assembly member suggests.</p>
<p>When reached for comment on the health care cuts and whether the Assembly is prepared to return to Albany to deal with the situation, Mike Whyland, spokesperson for Assembly Speaker Carl Heastie, said, “We care deeply about these hospitals and are closely monitoring it.”</p>
<p>A spokesperson for Senate Majority Leader John Flanagan did not respond to a request for comment.&nbsp;</p>
<p>

</p>A Victory for School Based Health Centers, But More To Do2017-08-24T04:00:00+00:002017-08-24T04:00:00+00:00http://www.gothamgazette.com/?id=7151:a-victory-for-school-based-health-centers-but-more-to-doBen Max<p><img src="http://www.gothamgazette.com/images/graphics/2017/carroll_simon.jpg" alt="carroll simon" width="600" /></p>
<p>Assemblymembers Carroll &amp; Simon, the authors (photo via @Bobby4Brooklyn)</p>
<hr />
<p>School based health centers (SBHCs) are a critical safety net for immigrants and the uninsured. There are 145 SBHCs serving students in more than 345 schools across the city, regardless of their ability to pay. SBHCs provide primary and preventive care, reproductive and mental health care, and first aid; manage chronic illnesses; and more. From asthma and diabetes to food allergies and anxiety, these clinics can make the difference between life and death for many of our schoolchildren.</p>
<p>The clinics yield positive health outcomes and are cost-effective through their provision of preventive health care. They are also wildly popular with parents, students, and school administrators. The city wholeheartedly supports the clinics, which have been shown to reduce absenteeism and enhance school performance. The clinics also fulfill the state’s goal of access to community-based care.</p>
<p>Therefore, it was alarming when four schools in&nbsp;District 15 received a letter in June from SUNY Downstate Medical Center, which operates five SBHCs, informing them that state funding had been dramatically reduced and that the SUNY Downstate SBHCs were in jeopardy.&nbsp;</p>
<p>A combination of a 20% cut in non-Medicaid funding in the 2017-18 State Budget ($3.9M), a May 2017 change by the State Department of Health to the funding methodology for the distribution of non-Medicaid funds, and a July 1, 2018 deadline to be carved-in to Medicaid Managed Care has created underfunding and instability to the SBHCs.&nbsp;</p>
<p>SUNY Downstate was a big loser in the state’s funding methodology changes that followed closely on the heels of the state’s budget cuts: SUNY Downstate’s budget for 2017-18 was slashed by 70%, from $669,322 to $198,187. While some sponsors received more money and are scheduled to open new centers this year, some of the larger sponsors took significant blows to their budget; NYU Lutheran Family Health Centers also took a cut of over $500,000, as did Mt. Sinai Hospital, which experienced a nearly $700,000 loss.</p>
<p>SUNY Downstate later announced that the cuts were unsustainable and that it could not operate four of its five centers. This included the centers at M.S. 51 William Alexander; Brooklyn New School (BNS) and Brooklyn School for Collaborative Studies; P.S. 38 the Pacific School; and the School for International Studies and Digital Arts and Cinema Technology High School.</p>
<p>Quickly, a coalition of parents, administrators, community leaders, labor unions, and elected officials came together to organize and fight back and everyone pitched in.&nbsp;An online petition in support of the centers was launched by the local elected officials. Jeremy Amar, a parent at MS 51, created posters of several student beneficiaries of the SBHCs with the slogan: “save your school based health center; community health starts here.” Amy Sumner, a parent coordinator from BNS 146, put out the call for personal stories about an SBHC and they poured in.</p>
<p>Thankfully, the coalition’s advocacy efforts were successful. SUNY Downstate decided that no matter the level of state funding that it received, it will continue to operate the four clinics for this year.&nbsp;We are very grateful that SUNY Downstate has stepped up for our children, but recognize the need to ensure the long-term viability of the SBHCs. It’s very likely that we will need to find a new sponsor for the four centers next year and we all need to make sure SBHCs across the city and state are properly funded going forward.</p>
<p>According to a study by the Children’s Defense Fund, next year’s Medicaid carve-in will reduce revenues to SBHCs by $16.3 million -- on top of this year’s cuts. Legislation was passed by the State Legislature to enact a permanent Medicaid Managed Carve-Out for SBHCs (A7866 /S6012). We are hopeful that Governor Cuomo will sign that bill into law by the end of the year.</p>
<p>SBHCs are only one piece in a very complex and large health care system, but this experience has demonstrated that these small pieces often have a significant impact on the daily lives of New Yorkers and their children. We are proud that our coalition came together to save these clinics because they are vital to the health of our students in District 15 and as elected members of the state Assembly we are committed to seeing to it that they are preserved for many school years to come.&nbsp;</p>
<p>***<br /> By Robert Carroll, Assemblymember, 44th District, &amp; Jo Anne Simon, Assemblymember, 52nd District. On Twitter <a href="https://twitter.com/Bobby4Brooklyn" target="_blank" rel="noopener noreferrer">@Bobby4Brooklyn</a> &amp; <a href="https://twitter.com/JoAnneSimonBK52" target="_blank" rel="noopener noreferrer">@JoAnneSimonBK52</a>.</p>
<p>

</p><p><img src="http://www.gothamgazette.com/images/graphics/2017/carroll_simon.jpg" alt="carroll simon" width="600" /></p>
<p>Assemblymembers Carroll &amp; Simon, the authors (photo via @Bobby4Brooklyn)</p>
<hr />
<p>School based health centers (SBHCs) are a critical safety net for immigrants and the uninsured. There are 145 SBHCs serving students in more than 345 schools across the city, regardless of their ability to pay. SBHCs provide primary and preventive care, reproductive and mental health care, and first aid; manage chronic illnesses; and more. From asthma and diabetes to food allergies and anxiety, these clinics can make the difference between life and death for many of our schoolchildren.</p>
<p>The clinics yield positive health outcomes and are cost-effective through their provision of preventive health care. They are also wildly popular with parents, students, and school administrators. The city wholeheartedly supports the clinics, which have been shown to reduce absenteeism and enhance school performance. The clinics also fulfill the state’s goal of access to community-based care.</p>
<p>Therefore, it was alarming when four schools in&nbsp;District 15 received a letter in June from SUNY Downstate Medical Center, which operates five SBHCs, informing them that state funding had been dramatically reduced and that the SUNY Downstate SBHCs were in jeopardy.&nbsp;</p>
<p>A combination of a 20% cut in non-Medicaid funding in the 2017-18 State Budget ($3.9M), a May 2017 change by the State Department of Health to the funding methodology for the distribution of non-Medicaid funds, and a July 1, 2018 deadline to be carved-in to Medicaid Managed Care has created underfunding and instability to the SBHCs.&nbsp;</p>
<p>SUNY Downstate was a big loser in the state’s funding methodology changes that followed closely on the heels of the state’s budget cuts: SUNY Downstate’s budget for 2017-18 was slashed by 70%, from $669,322 to $198,187. While some sponsors received more money and are scheduled to open new centers this year, some of the larger sponsors took significant blows to their budget; NYU Lutheran Family Health Centers also took a cut of over $500,000, as did Mt. Sinai Hospital, which experienced a nearly $700,000 loss.</p>
<p>SUNY Downstate later announced that the cuts were unsustainable and that it could not operate four of its five centers. This included the centers at M.S. 51 William Alexander; Brooklyn New School (BNS) and Brooklyn School for Collaborative Studies; P.S. 38 the Pacific School; and the School for International Studies and Digital Arts and Cinema Technology High School.</p>
<p>Quickly, a coalition of parents, administrators, community leaders, labor unions, and elected officials came together to organize and fight back and everyone pitched in.&nbsp;An online petition in support of the centers was launched by the local elected officials. Jeremy Amar, a parent at MS 51, created posters of several student beneficiaries of the SBHCs with the slogan: “save your school based health center; community health starts here.” Amy Sumner, a parent coordinator from BNS 146, put out the call for personal stories about an SBHC and they poured in.</p>
<p>Thankfully, the coalition’s advocacy efforts were successful. SUNY Downstate decided that no matter the level of state funding that it received, it will continue to operate the four clinics for this year.&nbsp;We are very grateful that SUNY Downstate has stepped up for our children, but recognize the need to ensure the long-term viability of the SBHCs. It’s very likely that we will need to find a new sponsor for the four centers next year and we all need to make sure SBHCs across the city and state are properly funded going forward.</p>
<p>According to a study by the Children’s Defense Fund, next year’s Medicaid carve-in will reduce revenues to SBHCs by $16.3 million -- on top of this year’s cuts. Legislation was passed by the State Legislature to enact a permanent Medicaid Managed Carve-Out for SBHCs (A7866 /S6012). We are hopeful that Governor Cuomo will sign that bill into law by the end of the year.</p>
<p>SBHCs are only one piece in a very complex and large health care system, but this experience has demonstrated that these small pieces often have a significant impact on the daily lives of New Yorkers and their children. We are proud that our coalition came together to save these clinics because they are vital to the health of our students in District 15 and as elected members of the state Assembly we are committed to seeing to it that they are preserved for many school years to come.&nbsp;</p>
<p>***<br /> By Robert Carroll, Assemblymember, 44th District, &amp; Jo Anne Simon, Assemblymember, 52nd District. On Twitter <a href="https://twitter.com/Bobby4Brooklyn" target="_blank" rel="noopener noreferrer">@Bobby4Brooklyn</a> &amp; <a href="https://twitter.com/JoAnneSimonBK52" target="_blank" rel="noopener noreferrer">@JoAnneSimonBK52</a>.</p>
<p>

</p>100 Years Later, Planned Parenthood of NYC is Still Growing to Meet New Yorkers’ Needs2016-10-28T04:00:00+00:002016-10-28T04:00:00+00:00http://www.gothamgazette.com/?id=6597:100-years-later-planned-parenthood-of-nyc-is-still-growing-to-meet-new-yorkers-needsBen Max<p><img src="http://www.gothamgazette.com/images/graphics/2016/ppnyc100.jpg" alt="ppnyc100" width="600" height="363" />&nbsp;</p>
<p>PPNYC celebrates 100 years with First Lady McCray</p>
<hr />
<p>One hundred years ago, in 1916, Planned Parenthood of New York City (PPNYC) opened in Brownsville, Brooklyn as a small birth control clinic. Since then, PPNYC has grown to five health centers—one in each borough—and provides sexual and reproductive health care services and information to more than 64,000 New Yorkers each year, and reaches another 25,000 through our extensive sex education programs.</p>
<p>Incredible gains have been made over the past century. PPNYC has been at the forefront of increasing access to birth control, ensuring the availability of safe and legal abortion, and getting coverage for preventive care and birth control under the Affordable Care Act. Today, we continue to be a champion for access to sexual and reproductive health care, improving sexuality education, and advocating for policies that make the lives of New Yorkers better every day.</p>
<p>But even with all the progress we’ve made, we are only just getting started. As the city has grown, we’ve changed and adapted as the communities we serve have changed. Our goal is to expand our services to better meet the needs of all New Yorkers—including men, young adults, gender nonconforming people, and the LGBTQ community.</p>
<p>Today, PPNYC continues to serve Brownsville not as a stand-alone clinic, but through Project Street Beat, an innovative street-based outreach program that provides HIV prevention services and counseling. The Project Street Beat - Keith Haring Foundation Mobile Medical Unit delivers care to some of our city’s most vulnerable individuals by meeting them right in their own community. This year, PPNYC is rolling out new services to provide more care to the communities we serve. In August, we began offering PrEP at our health centers, a daily pill that helps prevent HIV. By the end of 2016, we’ll be offering vasectomies and transgender hormone therapy.</p>
<p>Providing welcoming and trans-affirming care is essential to meet our goal of providing the best possible health care to all New Yorkers. And as always, our services are offered to everyone who comes through our doors—regardless of immigration status or ability to pay.</p>
<p>Along with our new services, our Education Department is also expanding and developing innovative strategies to reach even more New Yorkers, including the launch of a new program called Sexuality Education for Adults. Additionally, Promotores de Salud, PPNYC’s initiative that trains neighborhood residents to serve as peer health educators in the community, will partner with Project Street Beat to offer medical interpreting alongside sexual and reproductive health services.</p>
<p>PPNYC’s work is grounded in the idea that reproductive health and rights are closely intertwined with social justice issues. Many of the communities that we serve experience systemic oppressions dictated by race, gender, ethnicity, income, immigration status, ability, and more. We work alongside community-based organizations and reproductive justice organizations in the fight for a world where access to health care and rights are a reality for all people.</p>
<p>We are determined to fight for this goal now and always, and we are committed to improving the lives of New Yorkers—no matter what. We are 100 years strong and getting stronger. Our vision has always been to work toward a world where people have full control of their bodies and destinies. As we commemorate the extraordinary achievements made over our first 100 years, we are proud to launch our second century with as much passion, courage and conviction as our first.</p>
<p>***<br />Joan Malin is President and CEO of <a href="http://www.ppnyc.org" target="_blank">Planned Parenthood of New York City</a>.</p>
<p>

</p><p><img src="http://www.gothamgazette.com/images/graphics/2016/ppnyc100.jpg" alt="ppnyc100" width="600" height="363" />&nbsp;</p>
<p>PPNYC celebrates 100 years with First Lady McCray</p>
<hr />
<p>One hundred years ago, in 1916, Planned Parenthood of New York City (PPNYC) opened in Brownsville, Brooklyn as a small birth control clinic. Since then, PPNYC has grown to five health centers—one in each borough—and provides sexual and reproductive health care services and information to more than 64,000 New Yorkers each year, and reaches another 25,000 through our extensive sex education programs.</p>
<p>Incredible gains have been made over the past century. PPNYC has been at the forefront of increasing access to birth control, ensuring the availability of safe and legal abortion, and getting coverage for preventive care and birth control under the Affordable Care Act. Today, we continue to be a champion for access to sexual and reproductive health care, improving sexuality education, and advocating for policies that make the lives of New Yorkers better every day.</p>
<p>But even with all the progress we’ve made, we are only just getting started. As the city has grown, we’ve changed and adapted as the communities we serve have changed. Our goal is to expand our services to better meet the needs of all New Yorkers—including men, young adults, gender nonconforming people, and the LGBTQ community.</p>
<p>Today, PPNYC continues to serve Brownsville not as a stand-alone clinic, but through Project Street Beat, an innovative street-based outreach program that provides HIV prevention services and counseling. The Project Street Beat - Keith Haring Foundation Mobile Medical Unit delivers care to some of our city’s most vulnerable individuals by meeting them right in their own community. This year, PPNYC is rolling out new services to provide more care to the communities we serve. In August, we began offering PrEP at our health centers, a daily pill that helps prevent HIV. By the end of 2016, we’ll be offering vasectomies and transgender hormone therapy.</p>
<p>Providing welcoming and trans-affirming care is essential to meet our goal of providing the best possible health care to all New Yorkers. And as always, our services are offered to everyone who comes through our doors—regardless of immigration status or ability to pay.</p>
<p>Along with our new services, our Education Department is also expanding and developing innovative strategies to reach even more New Yorkers, including the launch of a new program called Sexuality Education for Adults. Additionally, Promotores de Salud, PPNYC’s initiative that trains neighborhood residents to serve as peer health educators in the community, will partner with Project Street Beat to offer medical interpreting alongside sexual and reproductive health services.</p>
<p>PPNYC’s work is grounded in the idea that reproductive health and rights are closely intertwined with social justice issues. Many of the communities that we serve experience systemic oppressions dictated by race, gender, ethnicity, income, immigration status, ability, and more. We work alongside community-based organizations and reproductive justice organizations in the fight for a world where access to health care and rights are a reality for all people.</p>
<p>We are determined to fight for this goal now and always, and we are committed to improving the lives of New Yorkers—no matter what. We are 100 years strong and getting stronger. Our vision has always been to work toward a world where people have full control of their bodies and destinies. As we commemorate the extraordinary achievements made over our first 100 years, we are proud to launch our second century with as much passion, courage and conviction as our first.</p>
<p>***<br />Joan Malin is President and CEO of <a href="http://www.ppnyc.org" target="_blank">Planned Parenthood of New York City</a>.</p>
<p>

</p>To Prevent Zika Threats, Reproductive Health Care is Necessary2016-08-21T04:00:00+00:002016-08-21T04:00:00+00:00http://www.gothamgazette.com/?id=6490:to-prevent-zika-threats-reproductive-health-care-is-necessaryBen Max<p><img src="http://www.gothamgazette.com/images/graphics/2014/03/bassett_mayor_zika_nychealthy.jpg" alt="bassett mayor zika nychealthy" width="600" height="338" /></p>
<p dir="ltr">City's health commissioner, Dr. Mary Bassett, discusses Zika (photo: @nychealthy)</p>
<hr />
<p dir="ltr">As the Zika virus continues to make headlines around the world, it is crucial that our city, state and federal governments do all that they can to prevent the spread of Zika. This is especially important in New York City, home to approximately 25% of the cases in the United States. &nbsp;&nbsp;</p>
<p dir="ltr">Our elected officials are doing just that. The Mayor&rsquo;s Office has unveiled <a href="http://www1.nyc.gov/office-of-the-mayor/news/365-16/mayor-de-blasio-three-year-five-borough-plan-protect-new-yorkers-the-zika-virus#/0" target="_blank">a three-year plan</a> focused on increasing clinical services, controlling mosquito populations, and raising public awareness through media campaigns and outreach to over 200 health care providers that serve New York City women. Additionally, just this week, New York City Public Advocate Letitia James&nbsp;<a href="http://advocate.nyc.gov/news/articles/pa-james-announces-recommendations-protect-new-yorkers-zika-virus">put forth a list of recommendations</a>&nbsp;to prevent the spread of Zika in our city, which among its many important proposals, calls for more education and increased access to sexual and reproductive health services to protect New Yorkers from exposure to Zika and its related health risks.</p>
<p dir="ltr">Zika is primarily spread by mosquito bites. However, we now understand that it can also be transmitted sexually. The <a href="http://www.cdc.gov/zika/prevention/protect-yourself-during-sex.html" target="_blank">CDC recommends</a> that men with symptoms abstain from sex or use condoms for at least six months and that all people who travel to places where Zika is spreading abstain from sex for at least eight weeks or use barrier methods like condoms or dental dams, whether they have symptoms or not.</p>
<p dir="ltr">At Planned Parenthood of New York City, we have long recognized how integral it is to public health that all people have the services and information they need to decide if and when to have children, and to protect their sexual health. This is even more critical with the threat of the Zika virus and its effects on infant development.</p>
<p dir="ltr">As one of the city&rsquo;s leading provider of high-quality sexual and reproductive health care services, PPNYC delivers the care New Yorkers need to reduce the likelihood of sexual transmission of Zika through the provision of condoms and other forms of birth control that can prevent or delay pregnancy until the risk has passed.</p>
<p dir="ltr">Additionally, we understand that in the face of Zika, it is imperative that we continue to protect access to safe and legal abortion. As of August 2016, <a href="http://www.ibtimes.com/zika-virus-new-york-city-49-cases-confirmed-pregnant-women-2402761" target="_blank">49 pregnant women have tested positive for the Zika virus</a> in New York City. PPNYC is committed to making sure that all people have the information and services necessary to make the best decision for them, whether that is to prevent unintended pregnancy, safely end a pregnancy, or carry a pregnancy to term and raise a child.</p>
<p dir="ltr">The importance of sexual and reproductive health services to public health cannot be overstated.</p>
<p dir="ltr">We <a href="http://newyork.cbslocal.com/2016/08/16/de-blasio-zika-congress-funding/" target="_blank">applaud Mayor de Blasio</a> and Public Advocate James for emphasizing the importance of stemming the spread of Zika, and for recognizing how PPNYC&rsquo;s services can help ensure that all New Yorkers have the resources and care they need to protect themselves and their families against Zika.</p>
<p dir="ltr">PPNYC is proud to be working alongside our city&rsquo;s other health care providers and elected officials to reduce the transmission of the Zika virus to keep New Yorkers healthy.</p>
<p dir="ltr">***<br />Joan Malin is President and CEO of <a href="https://www.plannedparenthood.org/planned-parenthood-new-york-city" target="_blank">Planned Parenthood of New York City</a>.</p>
<p>

</p><p><img src="http://www.gothamgazette.com/images/graphics/2014/03/bassett_mayor_zika_nychealthy.jpg" alt="bassett mayor zika nychealthy" width="600" height="338" /></p>
<p dir="ltr">City's health commissioner, Dr. Mary Bassett, discusses Zika (photo: @nychealthy)</p>
<hr />
<p dir="ltr">As the Zika virus continues to make headlines around the world, it is crucial that our city, state and federal governments do all that they can to prevent the spread of Zika. This is especially important in New York City, home to approximately 25% of the cases in the United States. &nbsp;&nbsp;</p>
<p dir="ltr">Our elected officials are doing just that. The Mayor&rsquo;s Office has unveiled <a href="http://www1.nyc.gov/office-of-the-mayor/news/365-16/mayor-de-blasio-three-year-five-borough-plan-protect-new-yorkers-the-zika-virus#/0" target="_blank">a three-year plan</a> focused on increasing clinical services, controlling mosquito populations, and raising public awareness through media campaigns and outreach to over 200 health care providers that serve New York City women. Additionally, just this week, New York City Public Advocate Letitia James&nbsp;<a href="http://advocate.nyc.gov/news/articles/pa-james-announces-recommendations-protect-new-yorkers-zika-virus">put forth a list of recommendations</a>&nbsp;to prevent the spread of Zika in our city, which among its many important proposals, calls for more education and increased access to sexual and reproductive health services to protect New Yorkers from exposure to Zika and its related health risks.</p>
<p dir="ltr">Zika is primarily spread by mosquito bites. However, we now understand that it can also be transmitted sexually. The <a href="http://www.cdc.gov/zika/prevention/protect-yourself-during-sex.html" target="_blank">CDC recommends</a> that men with symptoms abstain from sex or use condoms for at least six months and that all people who travel to places where Zika is spreading abstain from sex for at least eight weeks or use barrier methods like condoms or dental dams, whether they have symptoms or not.</p>
<p dir="ltr">At Planned Parenthood of New York City, we have long recognized how integral it is to public health that all people have the services and information they need to decide if and when to have children, and to protect their sexual health. This is even more critical with the threat of the Zika virus and its effects on infant development.</p>
<p dir="ltr">As one of the city&rsquo;s leading provider of high-quality sexual and reproductive health care services, PPNYC delivers the care New Yorkers need to reduce the likelihood of sexual transmission of Zika through the provision of condoms and other forms of birth control that can prevent or delay pregnancy until the risk has passed.</p>
<p dir="ltr">Additionally, we understand that in the face of Zika, it is imperative that we continue to protect access to safe and legal abortion. As of August 2016, <a href="http://www.ibtimes.com/zika-virus-new-york-city-49-cases-confirmed-pregnant-women-2402761" target="_blank">49 pregnant women have tested positive for the Zika virus</a> in New York City. PPNYC is committed to making sure that all people have the information and services necessary to make the best decision for them, whether that is to prevent unintended pregnancy, safely end a pregnancy, or carry a pregnancy to term and raise a child.</p>
<p dir="ltr">The importance of sexual and reproductive health services to public health cannot be overstated.</p>
<p dir="ltr">We <a href="http://newyork.cbslocal.com/2016/08/16/de-blasio-zika-congress-funding/" target="_blank">applaud Mayor de Blasio</a> and Public Advocate James for emphasizing the importance of stemming the spread of Zika, and for recognizing how PPNYC&rsquo;s services can help ensure that all New Yorkers have the resources and care they need to protect themselves and their families against Zika.</p>
<p dir="ltr">PPNYC is proud to be working alongside our city&rsquo;s other health care providers and elected officials to reduce the transmission of the Zika virus to keep New Yorkers healthy.</p>
<p dir="ltr">***<br />Joan Malin is President and CEO of <a href="https://www.plannedparenthood.org/planned-parenthood-new-york-city" target="_blank">Planned Parenthood of New York City</a>.</p>
<p>

</p>A Budget for the City of Immigrants2016-05-24T15:21:53+00:002016-05-24T15:21:53+00:00http://www.gothamgazette.com/?id=6353:a-budget-for-the-city-of-immigrantsAaron Holmes<p>&nbsp;<img src="http://www.gothamgazette.com/images/graphics/2015/adult-lit-classes-12.jpg" width="600" height="450" alt="adult lit classes 12" /></p>
<p>Students of an adult literacy class (photo: Make the Road New York)</p>
<hr />
<p>In recent years, New York City has taken major strides forward in its engagement with immigrant communities. Under the leadership of Mayor Bill de Blasio, City Council Speaker Melissa Mark-Viverito, and the Council as a whole, our city has adopted and invested in new initiatives to welcome and protect immigrants and embrace their tremendous economic, cultural, and political contributions.</p>
<p>Now, with the 2017 budget process in final negotiations, our leaders have a key opportunity to further address the barriers to opportunity and equity that immigrant communities continue to face. That’s why today, five leading immigrant organizations are releasing a new report, “<a href="http://www.maketheroad.org/report.php?ID=4279" target="_blank">A Budget for the City of Immigrants</a>,” which identifies key policy areas in which immigrant communities need further investment.</p>
<p>Despite path-breaking initiatives like IDNYC (the municipal identification card program), ActionNYC (one of the nation’s first large-scale municipal navigation and outreach programs to connect people to free immigration legal screenings), and the New York Immigrant Family Unity Project (the nation’s first program to guarantee counsel to low-income immigrants facing deportation), immigrants still face enormous challenges in accessing public services, getting the support to succeed in the workforce, and being informed of their rights.</p>
<p>The new report highlights key priorities across various issue areas, ranging from adult education to youth programs to health care access, but a few priorities bear particular mention.</p>
<p>First, our City must expand its investment in adult literacy to a baselined $16 million per year.</p>
<p>Adult newcomers who have come here to work and support their families often struggle with limited English proficiency (LEP). Despite enormous demand for adult literacy classes, supply has lagged—less than three percent of those in need can access community-based adult education programs. A recent Make the Road New York and Center for Popular Democracy report, “<a href="http://www.maketheroad.org/report.php?ID=4259" target="_blank">Teaching Toward Equity</a>: The Importance of English Classes to Reducing Economic Inequality in New York,” highlights how meeting the language needs of LEP New Yorkers would both further immigrant integration and generate billions of dollars in new earnings. New York City can lead again by making sure that adult immigrants can learn English and develop the tools they need to thrive.</p>
<p>Second, our city must direct $13.5 million for immigration legal services for complex cases.</p>
<p>Currently, New York City provides few resources for complex immigration legal cases where an individual is facing imminent deportation yet cannot be served under most existing funding streams. This leaves thousands of immigrants on waiting lists. A survey by the New York Immigration Coalition of the city's legal services providers noted that 60% of immigrants seeking their services had complex cases that need intensive representation. Further resources must focus on these complex immigration cases—especially for families who are on the verge of being torn apart without adequate legal representation.</p>
<p>Third, our city must expand its investment in Access Health NYC to $5 million.</p>
<p>This new City Council initiative has shown tremendous promise by working with community organizations like the Coalition for Asian American Children and Families to educate immigrants about health care options and enroll them for coverage, wherever possible. Health care access is another area where our city has shown leadership, and it should expand its commitment in this budget year.</p>
<p>Fourth, our city must move forward with the investment of $868 million in capital funding for the construction of new classrooms and schools to combat overcrowding and pursue additional means to meet the more than 100,000 school seats needed citywide.</p>
<p>The 2017 budget must include strong investment to address this widespread problem, while our leaders explore further action in future years to fix it once and for all.</p>
<p>Finally, New York City must take further steps to strengthen the landscape of grassroots, immigrant-led nonprofit organizations that are the backbone of our communities yet often struggle, as the Asian American Federation and the Federation of Protestant Welfare Agencies have noted, to operate on a level playing field with larger organizations.</p>
<p>By increasing the Nonprofit Stabilization Fund to $5 million and amending municipal contracting policies to open new opportunities for these smaller organizations, the city can go a long way to strengthening immigrant communities as well.</p>
<p>The priorities outlined in A Budget for the City of Immigrants, of which these are just a few, show concrete opportunities to consolidate the progress our city has made with respect to immigrant communities and ensure that we continue to move forward. With immigrant communities at the heart of our global city, we must use this budget cycle to continue to lead the way in welcoming and protecting immigrants.</p>
<p>What is good for immigrant communities is good for New York City, the city of immigrants.</p>
<p>***<br /><em>Javier H. Valdés is the Co-Executive Director of Make the Road New York. Steve Choi is the Executive Director of the New York Immigration Coalition. On Twitter: <a href="http://twitter.com/maketheroadny" target="_blank">@MaketheRoadNY</a> &amp; <a href="http://twitter.com/thenyic" target="_blank">@thenyic</a>.</em></p>
<p>

</p><p>&nbsp;<img src="http://www.gothamgazette.com/images/graphics/2015/adult-lit-classes-12.jpg" width="600" height="450" alt="adult lit classes 12" /></p>
<p>Students of an adult literacy class (photo: Make the Road New York)</p>
<hr />
<p>In recent years, New York City has taken major strides forward in its engagement with immigrant communities. Under the leadership of Mayor Bill de Blasio, City Council Speaker Melissa Mark-Viverito, and the Council as a whole, our city has adopted and invested in new initiatives to welcome and protect immigrants and embrace their tremendous economic, cultural, and political contributions.</p>
<p>Now, with the 2017 budget process in final negotiations, our leaders have a key opportunity to further address the barriers to opportunity and equity that immigrant communities continue to face. That’s why today, five leading immigrant organizations are releasing a new report, “<a href="http://www.maketheroad.org/report.php?ID=4279" target="_blank">A Budget for the City of Immigrants</a>,” which identifies key policy areas in which immigrant communities need further investment.</p>
<p>Despite path-breaking initiatives like IDNYC (the municipal identification card program), ActionNYC (one of the nation’s first large-scale municipal navigation and outreach programs to connect people to free immigration legal screenings), and the New York Immigrant Family Unity Project (the nation’s first program to guarantee counsel to low-income immigrants facing deportation), immigrants still face enormous challenges in accessing public services, getting the support to succeed in the workforce, and being informed of their rights.</p>
<p>The new report highlights key priorities across various issue areas, ranging from adult education to youth programs to health care access, but a few priorities bear particular mention.</p>
<p>First, our City must expand its investment in adult literacy to a baselined $16 million per year.</p>
<p>Adult newcomers who have come here to work and support their families often struggle with limited English proficiency (LEP). Despite enormous demand for adult literacy classes, supply has lagged—less than three percent of those in need can access community-based adult education programs. A recent Make the Road New York and Center for Popular Democracy report, “<a href="http://www.maketheroad.org/report.php?ID=4259" target="_blank">Teaching Toward Equity</a>: The Importance of English Classes to Reducing Economic Inequality in New York,” highlights how meeting the language needs of LEP New Yorkers would both further immigrant integration and generate billions of dollars in new earnings. New York City can lead again by making sure that adult immigrants can learn English and develop the tools they need to thrive.</p>
<p>Second, our city must direct $13.5 million for immigration legal services for complex cases.</p>
<p>Currently, New York City provides few resources for complex immigration legal cases where an individual is facing imminent deportation yet cannot be served under most existing funding streams. This leaves thousands of immigrants on waiting lists. A survey by the New York Immigration Coalition of the city's legal services providers noted that 60% of immigrants seeking their services had complex cases that need intensive representation. Further resources must focus on these complex immigration cases—especially for families who are on the verge of being torn apart without adequate legal representation.</p>
<p>Third, our city must expand its investment in Access Health NYC to $5 million.</p>
<p>This new City Council initiative has shown tremendous promise by working with community organizations like the Coalition for Asian American Children and Families to educate immigrants about health care options and enroll them for coverage, wherever possible. Health care access is another area where our city has shown leadership, and it should expand its commitment in this budget year.</p>
<p>Fourth, our city must move forward with the investment of $868 million in capital funding for the construction of new classrooms and schools to combat overcrowding and pursue additional means to meet the more than 100,000 school seats needed citywide.</p>
<p>The 2017 budget must include strong investment to address this widespread problem, while our leaders explore further action in future years to fix it once and for all.</p>
<p>Finally, New York City must take further steps to strengthen the landscape of grassroots, immigrant-led nonprofit organizations that are the backbone of our communities yet often struggle, as the Asian American Federation and the Federation of Protestant Welfare Agencies have noted, to operate on a level playing field with larger organizations.</p>
<p>By increasing the Nonprofit Stabilization Fund to $5 million and amending municipal contracting policies to open new opportunities for these smaller organizations, the city can go a long way to strengthening immigrant communities as well.</p>
<p>The priorities outlined in A Budget for the City of Immigrants, of which these are just a few, show concrete opportunities to consolidate the progress our city has made with respect to immigrant communities and ensure that we continue to move forward. With immigrant communities at the heart of our global city, we must use this budget cycle to continue to lead the way in welcoming and protecting immigrants.</p>
<p>What is good for immigrant communities is good for New York City, the city of immigrants.</p>
<p>***<br /><em>Javier H. Valdés is the Co-Executive Director of Make the Road New York. Steve Choi is the Executive Director of the New York Immigration Coalition. On Twitter: <a href="http://twitter.com/maketheroadny" target="_blank">@MaketheRoadNY</a> &amp; <a href="http://twitter.com/thenyic" target="_blank">@thenyic</a>.</em></p>
<p>

</p>Home Care Workers Need a Dedicated Advocate2016-05-22T04:00:00+00:002016-05-22T04:00:00+00:00http://www.gothamgazette.com/?id=6345:home-care-workers-need-a-dedicated-advocateBen Max<p><img src="http://www.gothamgazette.com/images/home_health.jpg" alt="home health" height="314" width="600" /></p>
<p>photo via PHI&nbsp;</p>
<hr />
<p>Nearly 175,000 New York City residents go to work each day in the homes of New Yorkers who are elderly or living with disabilities. Predominantly immigrant women of color, these aides assist with personal care, medications and other health-related tasks, meals, housekeeping, and a variety of other activities. They are crucial to keeping people who are frail or suffering from chronic illnesses healthy, safe, and independent. They have become vital to system reform efforts intended to improve the health of New Yorkers while also reducing costly and unnecessary visits to emergency rooms.</p>
<p>Home care workers, who may be home health aides or personal care aides, comprise the single largest occupational group in New York City. Nonetheless, they have a long history of marginalization: poverty-level wages, lack of standard labor protections, part-time hours, insufficient training and support on the job. That situation is beginning to change as policymakers recognize that the city faces a potential care crisis: a rapidly growing older population that requires a stable, skilled workforce to provide home care services.</p>
<p>Over the past five years, a raft of new federal, state, and local regulations - Wage Parity for personal care and home health aides, Domestic Workers Bill of Rights, and expansion of Fair Labor Standards Act to include home care aides - have been put in place to raise wages and improve working conditions. In addition, home care aides are affected by the rising minimum wage and new paid leave regulations. These measures are critical to improving the quality of home care jobs and attracting new workers, but they also have created a level of complexity that makes it difficult for employers to comply and for workers to know their rights.</p>
<p>The Wage Parity law requires that a home care aide be paid $10 per hour during the time she is with her client. She is paid minimum wage, currently $9 an hour, for travel time between clients. If her total number of weekly hours, including travel, is 45 hours, she must be paid time-and-a-half on her base wage for the hours over 40. The employer must calculate the base wage using a formula that accounts for hours worked ($10/hour) and paid travel time ($9/hour). How is this worker able to determine if she is being paid the right amount? What if she has an overnight shift? For how many hours should she be paid, and at what wage?</p>
<p>Both employers and home care aides need an unbiased source of information and assistance to navigate these rules and regulations. That is why PHI supports the proposal to include a Division of Paid Care, with a public advocate devoted to supporting the home care and day care workforces, in the new city Office of Labor Standards. For New York City’s home care workforce, this office could offer several crucial services:</p>
<p><strong>Education:</strong> Assist home care workers and their employers in learning about labor laws and regulations. For example, the advocate could spearhead public education on rules regarding compensation and labor protections. The advocate would also be available via a toll-free number to answer any questions workers had about their rights.</p>
<p><strong>Tracking and Reporting:</strong> Create a system for reporting complaints, cataloguing questions, and providing timely answers to frequently asked questions. An effective system would provide workers with a supportive environment in which to learn about their rights and file a complaint, if warranted. The advocate could track complaints and issue an annual report describing type and frequency, and propose appropriate measures to reduce violations.</p>
<p><strong>Assistance and Support:</strong> Help workers access state and local services for low-wage workers - for example, connecting workers to child care or health care resources. In addition, the advocate could provide information on available training programs and their costs.</p>
<p>To keep up with growing demand, it is estimated that New York City will need to grow its home care workforce 45 percent - more than 72,000 workers - over the next decade. To ensure quality home care services, New York City also needs to increase retention of well-trained, experienced aides. A Division of Paid Care could help to ensure quality jobs, with fair pay and adequate support, making home care a more attractive career for thousands of workers who could easily choose fast-food or other jobs over caring for the city’s most vulnerable elders.</p>
<p>***<br />Carol A. Rodat is the New York Policy Director for <a href="http://www.phinational.org/" target="_blank">PHI</a>, a national nonprofit affiliated with a New York health care system that includes Cooperative Home Care Associates, a worker-owned home care agency, and Independent Care System, a managed-care organization. On Twitter <a href="https://twitter.com/phinational/" target="_blank">@PHInational</a>.</p>
<p>

</p><p><img src="http://www.gothamgazette.com/images/home_health.jpg" alt="home health" height="314" width="600" /></p>
<p>photo via PHI&nbsp;</p>
<hr />
<p>Nearly 175,000 New York City residents go to work each day in the homes of New Yorkers who are elderly or living with disabilities. Predominantly immigrant women of color, these aides assist with personal care, medications and other health-related tasks, meals, housekeeping, and a variety of other activities. They are crucial to keeping people who are frail or suffering from chronic illnesses healthy, safe, and independent. They have become vital to system reform efforts intended to improve the health of New Yorkers while also reducing costly and unnecessary visits to emergency rooms.</p>
<p>Home care workers, who may be home health aides or personal care aides, comprise the single largest occupational group in New York City. Nonetheless, they have a long history of marginalization: poverty-level wages, lack of standard labor protections, part-time hours, insufficient training and support on the job. That situation is beginning to change as policymakers recognize that the city faces a potential care crisis: a rapidly growing older population that requires a stable, skilled workforce to provide home care services.</p>
<p>Over the past five years, a raft of new federal, state, and local regulations - Wage Parity for personal care and home health aides, Domestic Workers Bill of Rights, and expansion of Fair Labor Standards Act to include home care aides - have been put in place to raise wages and improve working conditions. In addition, home care aides are affected by the rising minimum wage and new paid leave regulations. These measures are critical to improving the quality of home care jobs and attracting new workers, but they also have created a level of complexity that makes it difficult for employers to comply and for workers to know their rights.</p>
<p>The Wage Parity law requires that a home care aide be paid $10 per hour during the time she is with her client. She is paid minimum wage, currently $9 an hour, for travel time between clients. If her total number of weekly hours, including travel, is 45 hours, she must be paid time-and-a-half on her base wage for the hours over 40. The employer must calculate the base wage using a formula that accounts for hours worked ($10/hour) and paid travel time ($9/hour). How is this worker able to determine if she is being paid the right amount? What if she has an overnight shift? For how many hours should she be paid, and at what wage?</p>
<p>Both employers and home care aides need an unbiased source of information and assistance to navigate these rules and regulations. That is why PHI supports the proposal to include a Division of Paid Care, with a public advocate devoted to supporting the home care and day care workforces, in the new city Office of Labor Standards. For New York City’s home care workforce, this office could offer several crucial services:</p>
<p><strong>Education:</strong> Assist home care workers and their employers in learning about labor laws and regulations. For example, the advocate could spearhead public education on rules regarding compensation and labor protections. The advocate would also be available via a toll-free number to answer any questions workers had about their rights.</p>
<p><strong>Tracking and Reporting:</strong> Create a system for reporting complaints, cataloguing questions, and providing timely answers to frequently asked questions. An effective system would provide workers with a supportive environment in which to learn about their rights and file a complaint, if warranted. The advocate could track complaints and issue an annual report describing type and frequency, and propose appropriate measures to reduce violations.</p>
<p><strong>Assistance and Support:</strong> Help workers access state and local services for low-wage workers - for example, connecting workers to child care or health care resources. In addition, the advocate could provide information on available training programs and their costs.</p>
<p>To keep up with growing demand, it is estimated that New York City will need to grow its home care workforce 45 percent - more than 72,000 workers - over the next decade. To ensure quality home care services, New York City also needs to increase retention of well-trained, experienced aides. A Division of Paid Care could help to ensure quality jobs, with fair pay and adequate support, making home care a more attractive career for thousands of workers who could easily choose fast-food or other jobs over caring for the city’s most vulnerable elders.</p>
<p>***<br />Carol A. Rodat is the New York Policy Director for <a href="http://www.phinational.org/" target="_blank">PHI</a>, a national nonprofit affiliated with a New York health care system that includes Cooperative Home Care Associates, a worker-owned home care agency, and Independent Care System, a managed-care organization. On Twitter <a href="https://twitter.com/phinational/" target="_blank">@PHInational</a>.</p>
<p>

</p>Clarity on the City's Investment in Health + Hospitals2016-05-13T04:00:00+00:002016-05-13T04:00:00+00:00http://www.gothamgazette.com/?id=6333:clarity-on-the-city-s-investment-in-health-hospitalsBen Max<p><img src="http://www.gothamgazette.com/images/Health_and_Hospitals_facebook.jpg" alt="Health and Hospitals facebook" height="400" width="600" /></p>
<p>(photo via Health + Hospitals on Facebook)</p>
<hr />
<p>New York City Health + Hospitals is a model public system, the country’s oldest and largest commitment to safety-net health care. Yet Mayor Bill de Blasio’s recent plan to shore up finances at Health + Hospitals has led to consternation from those who would have us believe that H+H is an oversized and outdated system.</p>
<p>In <a href="http://m.nydailynews.com/opinion/errol-louis-price-rescue-public-hospitals-article-1.2622198" target="_blank">a recent New York Daily News column</a>, Errol Louis made this argument while saying that the burden of undocumented immigrants is a key flaw in Health + Hospitals’ current structure. Misunderstandings and misrepresentations of this structure and Health + Hospitals’ role in today’s health care landscape and within the city budget are, unfortunately, becoming more widespread.</p>
<p>Concerns about the financial standing of such a critical community institution are merited. The solution, however, is to promote policies that support quality, cost-effective care at Health + Hospitals, starting with Mayor de Blasio’s budget proposal.</p>
<p>The suggestion that H+H is unable to keep up with the health care system’s changing tide away from hospital-based care and toward preventive, community-based services overlooks the fact that Health + Hospitals is already providing comprehensive and culturally competent services across the care spectrum, from primary care in more than 30 community healthcare centers and 25 school-based health centers, to its better-known network of 11 hospitals providing acute and ambulatory care.</p>
<p>H+H has a diverse staff that represents the culturally and linguistically diverse communities it serves. In recent years H+H has responded to almost 700,000 patient requests for interpreter services.</p>
<p>In his column, Mr. Louis cites a 2014 report that one-quarter of hospital admissions are avoidable. He is right, but this is a problem of health care in general, not of NYC Health + Hospitals specifically. New York State’s Delivery System Reform Incentive Payment (DSRIP) Program is currently providing health systems across the state $8 billion in incentive payments to better coordinate care and reduce avoidable hospitalizations by 25% by 2020. The largest of the state’s 25 DSRIP systems is spearheaded by none other than Health + Hospitals. Whether DSRIP is successful remains to be seen, but there is no doubt that Health + Hospitals is at the forefront of system change.</p>
<p>As a public network, Health + Hospitals provides care to anyone who needs it, regardless of ability to pay or immigration status. It is an important provider of care to the city’s 375,000 undocumented immigrants, who face daunting restrictions in access to both public and private insurance. Mr. Louis uses this fact to support his unfounded claim that undocumented immigrants crowd emergency rooms because they have nowhere else to go for their basic health needs.</p>
<p>The truth, demonstrated in rigorous public health studies, is that undocumented immigrants use health care services, including emergency rooms, at lower rates than U.S. citizens and other immigrants. Because Health + Hospitals provides comprehensive and coordinated services, undocumented immigrants do indeed use the public (read: primary care) system for “routine health needs,” as Mr. Louis says – exactly as they should.</p>
<p>Contributions to the tax base should not be a prerequisite for receiving health care in a modern, humane society, but it is worth noting that undocumented immigrants in New York state, about 70 percent of whom live in New York City, contributed $1.1 billion to the state’s economy in 2012, according to the Institute on Taxation &amp; Economic Policy. They are hardly free-riders.</p>
<p>In the true spirit of the safety net, Health + Hospitals provides care for uninsured patients, citizens and immigrants alike, without being reimbursed for it. This is a fundamental problem for the system’s finances. The solution is not to reconsider the mission of Health + Hospitals but to support policies that reduce unreimbursed care by promoting federal and state funding for health systems and increasing access to health coverage for those who remain uninsured. These are real, meaningful steps to ensure that health care providers are adequately reimbursed for services.</p>
<p>Mr. Louis casts the financial needs of the city’s public health system as a threat to education, transportation, and housing. Pitting public services against one another in this way is unfair and does not recognize that preservation of health is the foundation upon which New Yorkers take advantage of educational opportunity and lead rewarding, productive lives.</p>
<p>A city that abandons its obligation to fill the gaps in the frayed federal and state health care safety net does itself and its residents a disservice. New York City doesn’t need a smaller or less generous public Health + Hospitals system; it needs a system that is recognized for the value it provides to our communities and that is supported accordingly.</p>
<p>***<br />Max Hadler is the health advocacy specialist for the New York Immigration Coalition. On Twitter <a href="https://twitter.com/thenyic" target="_blank">@theNYIC</a>.</p>
<p>

</p><p><img src="http://www.gothamgazette.com/images/Health_and_Hospitals_facebook.jpg" alt="Health and Hospitals facebook" height="400" width="600" /></p>
<p>(photo via Health + Hospitals on Facebook)</p>
<hr />
<p>New York City Health + Hospitals is a model public system, the country’s oldest and largest commitment to safety-net health care. Yet Mayor Bill de Blasio’s recent plan to shore up finances at Health + Hospitals has led to consternation from those who would have us believe that H+H is an oversized and outdated system.</p>
<p>In <a href="http://m.nydailynews.com/opinion/errol-louis-price-rescue-public-hospitals-article-1.2622198" target="_blank">a recent New York Daily News column</a>, Errol Louis made this argument while saying that the burden of undocumented immigrants is a key flaw in Health + Hospitals’ current structure. Misunderstandings and misrepresentations of this structure and Health + Hospitals’ role in today’s health care landscape and within the city budget are, unfortunately, becoming more widespread.</p>
<p>Concerns about the financial standing of such a critical community institution are merited. The solution, however, is to promote policies that support quality, cost-effective care at Health + Hospitals, starting with Mayor de Blasio’s budget proposal.</p>
<p>The suggestion that H+H is unable to keep up with the health care system’s changing tide away from hospital-based care and toward preventive, community-based services overlooks the fact that Health + Hospitals is already providing comprehensive and culturally competent services across the care spectrum, from primary care in more than 30 community healthcare centers and 25 school-based health centers, to its better-known network of 11 hospitals providing acute and ambulatory care.</p>
<p>H+H has a diverse staff that represents the culturally and linguistically diverse communities it serves. In recent years H+H has responded to almost 700,000 patient requests for interpreter services.</p>
<p>In his column, Mr. Louis cites a 2014 report that one-quarter of hospital admissions are avoidable. He is right, but this is a problem of health care in general, not of NYC Health + Hospitals specifically. New York State’s Delivery System Reform Incentive Payment (DSRIP) Program is currently providing health systems across the state $8 billion in incentive payments to better coordinate care and reduce avoidable hospitalizations by 25% by 2020. The largest of the state’s 25 DSRIP systems is spearheaded by none other than Health + Hospitals. Whether DSRIP is successful remains to be seen, but there is no doubt that Health + Hospitals is at the forefront of system change.</p>
<p>As a public network, Health + Hospitals provides care to anyone who needs it, regardless of ability to pay or immigration status. It is an important provider of care to the city’s 375,000 undocumented immigrants, who face daunting restrictions in access to both public and private insurance. Mr. Louis uses this fact to support his unfounded claim that undocumented immigrants crowd emergency rooms because they have nowhere else to go for their basic health needs.</p>
<p>The truth, demonstrated in rigorous public health studies, is that undocumented immigrants use health care services, including emergency rooms, at lower rates than U.S. citizens and other immigrants. Because Health + Hospitals provides comprehensive and coordinated services, undocumented immigrants do indeed use the public (read: primary care) system for “routine health needs,” as Mr. Louis says – exactly as they should.</p>
<p>Contributions to the tax base should not be a prerequisite for receiving health care in a modern, humane society, but it is worth noting that undocumented immigrants in New York state, about 70 percent of whom live in New York City, contributed $1.1 billion to the state’s economy in 2012, according to the Institute on Taxation &amp; Economic Policy. They are hardly free-riders.</p>
<p>In the true spirit of the safety net, Health + Hospitals provides care for uninsured patients, citizens and immigrants alike, without being reimbursed for it. This is a fundamental problem for the system’s finances. The solution is not to reconsider the mission of Health + Hospitals but to support policies that reduce unreimbursed care by promoting federal and state funding for health systems and increasing access to health coverage for those who remain uninsured. These are real, meaningful steps to ensure that health care providers are adequately reimbursed for services.</p>
<p>Mr. Louis casts the financial needs of the city’s public health system as a threat to education, transportation, and housing. Pitting public services against one another in this way is unfair and does not recognize that preservation of health is the foundation upon which New Yorkers take advantage of educational opportunity and lead rewarding, productive lives.</p>
<p>A city that abandons its obligation to fill the gaps in the frayed federal and state health care safety net does itself and its residents a disservice. New York City doesn’t need a smaller or less generous public Health + Hospitals system; it needs a system that is recognized for the value it provides to our communities and that is supported accordingly.</p>
<p>***<br />Max Hadler is the health advocacy specialist for the New York Immigration Coalition. On Twitter <a href="https://twitter.com/thenyic" target="_blank">@theNYIC</a>.</p>
<p>

</p>Stand Against Racism, Protect Asian-American Women's Health2016-01-22T02:41:40+00:002016-01-22T02:41:40+00:00http://www.gothamgazette.com/?id=6108:stand-against-racism-protect-asian-american-womens-healthSuper User<p><img src="http://www.gothamgazette.com/images/graphics/2014/03/chin_council_hearing.jpg" alt="chin council hearing" width="600" height="400" /></p>
<p>Council Member Chin, one of the authors (photo: William Alatriste)</p>
<hr />
<p>New York City has the opportunity to support Asian-Americans and women's health by opposing deceptively named, so-called "sex-selective abortion bans."</p>
<p>These attacks on a woman's right to choose are wolves in sheep's clothing. At a glance, such bans might sound like laws meant to further women's rights. But they actually do just the opposite.</p>
<p>The tragic reality of "son preference" has been a serious issue in some countries, such as India and China, where women do not have the same rights and status that they have here. But male preference is not a widespread issue in the United States – not for any specific ethnic group or for the population as a whole. In fact, a recent <a href="https://ihrclinic.uchicago.edu/sites/ihrclinic.uchicago.edu/files/uploads/Replacing%20Myths%20with%20Facts%20-%20Sex-Selective%20Abortion%20Laws%20in%20the%20United%20States.pdf" target="_blank">study</a> conducted by the University of Chicago Law School finds that Asian-Americans are giving birth to more girls than white Americans.</p>
<p>Given these facts, the sex-selective bans <a href="http://www.guttmacher.org/statecenter/spibs/spib_SRSGAAB.pdf" target="_blank">being introduced</a> across the U.S. are disingenuous at best. They exploit a real problem around gender that has been well documented in other countries to harm the very communities they purport to help.</p>
<p>In an effort to draw attention to these harmful and offensive bans, we have drafted a resolution that was recently introduced in the City Council to put the City of New York on record in opposition to this latest attack on a woman's right to choose.</p>
<p>More than just an attack on reproductive health and family planning services, these bans promote ugly stereotypes about our community – namely, that we as Asian-Americans do not value the lives of our girls.</p>
<p>Many in the Asian-American community already face heightened barriers to accessing care, and laws like sex-selective abortion bans widen the gap. Sex-selective bans also damage the doctor-patient relationship by opening private medical decisions to scrutiny by both health-care providers and law enforcement.</p>
<p>This is not just bad policy; sex-selective abortion bans are dangerous to women's health and could have a chilling effect on women seeking health care. Under no circumstances should patient-doctor parenting discussions be called into question because of one's skin color or ethnicity.</p>
<p>Factors like immigration status, income and cultural and linguistic barriers already make it difficult for women in our community to get the health care they need. In New York City, <a href="http://www.aafederation.org/pdf/AAF_nyc2010report.pdf" target="_blank">49 percent</a> of Asian-American adults have limited English proficiency. And <a href="http://www.nyc.gov/html/doh/downloads/pdf/epi/databrief43.pdf" target="_blank">20 percent</a> of all Asian-Americans in the city are uninsured.</p>
<p>With New York City home to one of the largest Asian-American populations in the country, we must take a stand and demand that our state and federal colleagues work to ensure our communities have greater access to health care — not more restrictions.</p>
<p>In their myopic pursuit of an anti-choice agenda, some lawmakers are irresponsibly placing basic health care needs of the Asian American community at risk. And yet, despite the dangerous consequences, they are having some legislative success. In 2013 and 2014, sex-selective bans were the second most proposed type of abortion restriction in the country. Even New York State is not immune —this year, <a href="http://assembly.state.ny.us/leg/?default_fld=&amp;bn=A06545&amp;Summary=Y&amp;Actions=Y&amp;Text=Y&amp;Votes=Y" target="_blank">one such law</a> was introduced in the Assembly. We must stem the tide of these attacks.</p>
<p>By working together with advocates to introduce this <a href="http://legistar.council.nyc.gov/LegislationDetail.aspx?ID=2530982&amp;GUID=7868D0AB-FA6F-44F5-A415-C7838EF3D964" target="_blank">new resolution</a>, we are urging our city to take a stand against these offensive bans. If the City Council passes this important resolution, it could become the third city in the country to denounce this attack on access to health care and family planning for thousands of Asian-Americans.</p>
<p>New Yorkers deserve better. Join us in standing up against racism and supporting women's health by urging your City Council representative to support this important resolution.</p>
<p dir="ltr">***<br />by New York City Council Member <a href="http://council.nyc.gov/d1/html/members/home.shtml" target="_blank">Margaret Chin</a> and National Asian Pacific American Women’s Forum Executive Director <a href="https://napawf.org/about/staff/" target="_blank">Miriam Yeung.</a></p><p><img src="http://www.gothamgazette.com/images/graphics/2014/03/chin_council_hearing.jpg" alt="chin council hearing" width="600" height="400" /></p>
<p>Council Member Chin, one of the authors (photo: William Alatriste)</p>
<hr />
<p>New York City has the opportunity to support Asian-Americans and women's health by opposing deceptively named, so-called "sex-selective abortion bans."</p>
<p>These attacks on a woman's right to choose are wolves in sheep's clothing. At a glance, such bans might sound like laws meant to further women's rights. But they actually do just the opposite.</p>
<p>The tragic reality of "son preference" has been a serious issue in some countries, such as India and China, where women do not have the same rights and status that they have here. But male preference is not a widespread issue in the United States – not for any specific ethnic group or for the population as a whole. In fact, a recent <a href="https://ihrclinic.uchicago.edu/sites/ihrclinic.uchicago.edu/files/uploads/Replacing%20Myths%20with%20Facts%20-%20Sex-Selective%20Abortion%20Laws%20in%20the%20United%20States.pdf" target="_blank">study</a> conducted by the University of Chicago Law School finds that Asian-Americans are giving birth to more girls than white Americans.</p>
<p>Given these facts, the sex-selective bans <a href="http://www.guttmacher.org/statecenter/spibs/spib_SRSGAAB.pdf" target="_blank">being introduced</a> across the U.S. are disingenuous at best. They exploit a real problem around gender that has been well documented in other countries to harm the very communities they purport to help.</p>
<p>In an effort to draw attention to these harmful and offensive bans, we have drafted a resolution that was recently introduced in the City Council to put the City of New York on record in opposition to this latest attack on a woman's right to choose.</p>
<p>More than just an attack on reproductive health and family planning services, these bans promote ugly stereotypes about our community – namely, that we as Asian-Americans do not value the lives of our girls.</p>
<p>Many in the Asian-American community already face heightened barriers to accessing care, and laws like sex-selective abortion bans widen the gap. Sex-selective bans also damage the doctor-patient relationship by opening private medical decisions to scrutiny by both health-care providers and law enforcement.</p>
<p>This is not just bad policy; sex-selective abortion bans are dangerous to women's health and could have a chilling effect on women seeking health care. Under no circumstances should patient-doctor parenting discussions be called into question because of one's skin color or ethnicity.</p>
<p>Factors like immigration status, income and cultural and linguistic barriers already make it difficult for women in our community to get the health care they need. In New York City, <a href="http://www.aafederation.org/pdf/AAF_nyc2010report.pdf" target="_blank">49 percent</a> of Asian-American adults have limited English proficiency. And <a href="http://www.nyc.gov/html/doh/downloads/pdf/epi/databrief43.pdf" target="_blank">20 percent</a> of all Asian-Americans in the city are uninsured.</p>
<p>With New York City home to one of the largest Asian-American populations in the country, we must take a stand and demand that our state and federal colleagues work to ensure our communities have greater access to health care — not more restrictions.</p>
<p>In their myopic pursuit of an anti-choice agenda, some lawmakers are irresponsibly placing basic health care needs of the Asian American community at risk. And yet, despite the dangerous consequences, they are having some legislative success. In 2013 and 2014, sex-selective bans were the second most proposed type of abortion restriction in the country. Even New York State is not immune —this year, <a href="http://assembly.state.ny.us/leg/?default_fld=&amp;bn=A06545&amp;Summary=Y&amp;Actions=Y&amp;Text=Y&amp;Votes=Y" target="_blank">one such law</a> was introduced in the Assembly. We must stem the tide of these attacks.</p>
<p>By working together with advocates to introduce this <a href="http://legistar.council.nyc.gov/LegislationDetail.aspx?ID=2530982&amp;GUID=7868D0AB-FA6F-44F5-A415-C7838EF3D964" target="_blank">new resolution</a>, we are urging our city to take a stand against these offensive bans. If the City Council passes this important resolution, it could become the third city in the country to denounce this attack on access to health care and family planning for thousands of Asian-Americans.</p>
<p>New Yorkers deserve better. Join us in standing up against racism and supporting women's health by urging your City Council representative to support this important resolution.</p>
<p dir="ltr">***<br />by New York City Council Member <a href="http://council.nyc.gov/d1/html/members/home.shtml" target="_blank">Margaret Chin</a> and National Asian Pacific American Women’s Forum Executive Director <a href="https://napawf.org/about/staff/" target="_blank">Miriam Yeung.</a></p>As Healthcare Landscape Changes, City Hospital Authority Charts New Path2015-10-20T05:00:00+00:002015-10-20T05:00:00+00:00http://www.gothamgazette.com/?id=5939:as-healthcare-landscape-changes-city-hospital-authority-charts-new-pathSuper User<p dir="ltr"><img src="http://www.gothamgazette.com/images/Dr_Ram_Raju_via_Twitter_RamRajuMD.jpg" alt="Dr Ram Raju via Twitter RamRajuMD" width="600" height="400" /></p>
<p dir="ltr"><span style="font-size: 10pt;">HHC's Dr. Raju (photo: @RamRajuMD)</span>&nbsp;</p>
<hr />
<p>New York City’s Health and Hospitals Corporation was thrust into the spotlight a year ago when, last October, its Bellevue Hospital treated <a href="http://www.nytimes.com/2014/10/24/nyregion/craig-spencer-is-tested-for-ebola-virus-at-bellevue-hospital-in-new-york-city.html?action=click&amp;contentCollection=N.Y.%20/%20Region&amp;module=RelatedCoverage&amp;region=Marginalia&amp;pgtype=article" target="_blank">Craig Spencer</a>, the doctor who returned from West Africa with Ebola. But every day, HHC also serves many thousands of New Yorkers, some of them uninsured or undocumented. The quasi-public agency is one of the largest, yet perhaps least-understood parts of New York municipal government.</p>
<p dir="ltr">HHC plays a key role in providing New Yorkers health care, but it has operated on shaky financial footing and its current CEO, Dr. Ram Raju, who is appointed by the mayor, is overhauling its operations. This change comes at a critical time as insurance payment models, federal funding, and city residents’ needs are all changing.</p>
<p dir="ltr"><strong>What is HHC?</strong><br />HHC is a public-benefit corporation—similar to the MTA (Metropolitan Transportation Authority)—that runs the largest public hospital system in the United States. Consisting of 11 hospitals in four of New York City’s five boroughs, HHC treats around 1.4 million patients per year, according to its <a href="http://www.nyc.gov/html/hhc/downloads/pdf/publication/2014-hhc-report-to-the-community.pdf">2014 Report to the Community</a>. HHC also administers MetroPlus, a low-cost health insurance program open to New York City residents.</p>
<p dir="ltr">As a “safety-net” hospital whose stated goal is to provide healthcare “regardless of ability to pay,” around 80 percent of HHC patients are Medicare or Medicaid recipients, or uninsured. The system also serves the estimated 500,000 undocumented immigrants—of which 200,000 are undocumented and uninsured, <a href="http://www.undocumentedpatients.org/wp-content/uploads/2015/04/Undocumented-Immigrants-and-Access-to-Health-Care-NYC-Report-April-2015.pdf" target="_blank">according to</a> the New York Immigration Coalition—living in New York City.</p>
<p dir="ltr">Starting next year, HHC will also provide health services to inmates at city jails and prisons—a role Mayor Bill de Blasio assigned to the agency in June after a city <a href="http://www.nytimes.com/2015/06/11/nyregion/report-details-failings-of-corizon-rikers-island-health-provider.html?_r=0" target="_blank">investigation</a> revealed that contractor Corizon Health Inc. hired doctors with disciplinary problems and criminal convictions.</p>
<p dir="ltr">“De facto, it serves a lot of very vulnerable patients in New York, in very high volume,” said Andrea Cohen, senior vice president for program at the United Hospital Fund, a healthcare research and advocacy nonprofit. “What it does today is provide an essential safety net.”</p>
<p dir="ltr">At a November policy breakfast hosted by Citizens Budget Commission, HHC CEO Dr. Raju explained his general healthcare philosophy and the organizing principle behind HHC services. “I would argue,” he said, “you do have a stake in the good health of the cook preparing the meal in your favorite restaurant and the good health of your nanny, and the good health of your housekeeper. My health depends on that cook’s health, upon that maid’s health, upon your health.”</p>
<p dir="ltr">HHC was formed in 1969 to take over the city’s former Department of Hospitals. According to James Colgrove, a sociomedical sciences professor at Columbia, HHC was created partly in response to a perceived cost crisis earlier in the decade. With its own - albeit mayor-appointed - board of directors, HHC has “more bureaucratic flexibility and cost controls” than regular city agencies, Colgrove said. This means that HHC is more independant—both organizationally and financially—and less affected by changes in city policies and finances than typical city agencies.</p>
<p dir="ltr">The corporation’s <a href="http://council.nyc.gov/html/budget/2016/Pre/hhc.pdf" target="_blank">budget in fiscal year 2016</a>, which began July 1, is projected to be nearly $6.5 billion—of which only $215 million, or 3 percent, will come directly from the city. But with operational independence comes financial challenges--HHC projects an operating loss of more than $750 million in 2016, growing to $1.5 billion in 2019.</p>
<p dir="ltr"><strong>Ongoing and New Challenges</strong><br />According to HHC’s preliminary 2016 budget, the corporation’s past and projected deficits are due to years of New York State <a href="http://gothamgazette.com:8080/index.php/health/655-fights-over-medicaid-could-threaten-new-administrations-health" target="_blank">Medicaid cuts</a> combined with growing patient numbers. In 2014, more than 80 percent of HHC’s revenues were been from Medicaid- or Medicare-related fees. The remainder comes from non-Medicaid or Medicare fees and a variety of federal, state, and city grants.</p>
<p dir="ltr">President Barack Obama’s Affordable Care Act also includes reductions in Medicare and Disproportionate Share Hospital (DSH) funds—a form of supplemental Medicaid given to hospitals that serve large numbers of uninsured patients. The rationale behind these cuts is that with a smaller number of Americans uninsured, hospitals will not need as much federal funding—but that doesn’t mean HHC will benefit in the short-term. The corporation received $1.8 billion in DSH money in 2014—more than 27 percent of its intake that year—while it expects to only receive $1.2 billion by 2018.</p>
<p dir="ltr">HHC’s current financial situation isn’t new or surprising. That’s partly because it’s politically difficult to reorganize or close hospitals, institutions with large union staffs and high levels of community involvement. While running for mayor, de Blasio <a href="http://www.crainsnewyork.com/article/20140120/BLOGS04/140129989/de-blasio-vows-to-fight-hospital-closures" target="_blank">campaigned against</a> the planned closing of Long Island College Hospital in Brooklyn. Former Mayor Ed Koch’s decision to close HHC’s Sydenham Hospital in 1980, as part of an attempt to close a budget deficit, <a href="http://www1.cuny.edu/mu/forum/2015/03/10/mayor-ed-koch-calls-1980-sydenham-hospital-closing-a-mistake-in-latest-laguardia-and-wagner-archives-youtube-video/" target="_blank">sparked protests</a> across Harlem. “Concerns over cost are as old as hospitals themselves,” Colgrove said.</p>
<p dir="ltr">Debt-rating agency Fitch <a href="https://www.fitchratings.com/site/fitch-home/pressrelease?id=980011" target="_blank">affirmed</a> its ‘A-plus’ score on HHC bonds in February, saying HHC’s role as a safety-net provider positions it “well to secure sufficient levels of funding from city, state, and federal sources necessary to continue to operate and pay debt service.”</p>
<p dir="ltr"><strong>What lies ahead for HHC?</strong><br />Raju, appointed by de Blasio at the start of 2014, <a href="http://www.capitalnewyork.com/article/city-hall/2015/09/8577102/city-hospital-head-reorganize-hierarchy-emphasize-ambulatory-care" target="_blank">announced</a> in September plans to restructure HHC’s corporate hierarchy with the goal of ultimately expanding services and growing revenues. The plan came five months after Raju outlined his <a href="http://www.nyc.gov/html/hhc/html/news/press-release-20150407-dr-raju-public-address-way-forward-hhc-tomorrow.shtml" target="_blank">vision</a> for a financially stable HHC by 2020.</p>
<p dir="ltr">City Council members expressed concerns about HHC’s deficit during a <a href="http://www.capitalnewyork.com/article/city-hall/2015/05/8568498/council-alarmed-hhcs-15-b-deficit" target="_blank">budget hearing in May</a>. Watchdog group Citizens Budget Commission published a <a href="http://www.cbcny.org/sites/default/files/REPORT_HHC_11062014.pdf" target="_blank">report</a> last November describing the corporation’s “troubled” financial picture.</p>
<p dir="ltr">Raju’s plan is to replace HHC’s current structure of hospitals in a network with an organization based on lines of service. The new hierarchy will reduce bureaucracy and allow ambulatory and post-acute services to grow more quickly over the coming years, Raju <a href="http://capitalnewyork.com/article/city-hall/2015/09/8577102/city-hospital-head-reorganize-hierarchy-emphasize-ambulatory-care" target="_blank">told Politico New York</a> last month.</p>
<p dir="ltr">Cohen said Raju’s plan doesn’t pose immediate financial risks for HHC—but has a large upside potential should it succeed.</p>
<p dir="ltr">“[HHC] has had a deficit for a long time, but it has always found new ways to restructure,” Cohen said. “Dr. Raju’s strategy is growth, and it’s a very ambitious and positive strategy.” New payment models in healthcare, she added, “allow strategies which don’t just look at the cost side but caring for the full patient.”</p>
<p dir="ltr">Another part of Raju’s goal for 2020 is to expand HHC’s MetroPlus insurance membership to 1 million—an additional potential source of revenue. Although MetroPlus was the most popular plan on New York’s health insurance market in 2014 and more than 428,000 individuals were enrolled in 2015, that’s only a 7 percent increase compared to 2010.</p>
<p dir="ltr">“The whole system is really undergoing substantial transformation, and HHC has absolutely embraced it in a huge way, but it’s hard,” Cohen said. “There is execution risk, but they are ambitiously tackling it.”</p>
<p dir="ltr">***<br />by Christian Zhang, Gotham Gazette<br /><a href="https://twitter.com/GothamGazette" target="_blank">@GothamGazette</a></p><p dir="ltr"><img src="http://www.gothamgazette.com/images/Dr_Ram_Raju_via_Twitter_RamRajuMD.jpg" alt="Dr Ram Raju via Twitter RamRajuMD" width="600" height="400" /></p>
<p dir="ltr"><span style="font-size: 10pt;">HHC's Dr. Raju (photo: @RamRajuMD)</span>&nbsp;</p>
<hr />
<p>New York City’s Health and Hospitals Corporation was thrust into the spotlight a year ago when, last October, its Bellevue Hospital treated <a href="http://www.nytimes.com/2014/10/24/nyregion/craig-spencer-is-tested-for-ebola-virus-at-bellevue-hospital-in-new-york-city.html?action=click&amp;contentCollection=N.Y.%20/%20Region&amp;module=RelatedCoverage&amp;region=Marginalia&amp;pgtype=article" target="_blank">Craig Spencer</a>, the doctor who returned from West Africa with Ebola. But every day, HHC also serves many thousands of New Yorkers, some of them uninsured or undocumented. The quasi-public agency is one of the largest, yet perhaps least-understood parts of New York municipal government.</p>
<p dir="ltr">HHC plays a key role in providing New Yorkers health care, but it has operated on shaky financial footing and its current CEO, Dr. Ram Raju, who is appointed by the mayor, is overhauling its operations. This change comes at a critical time as insurance payment models, federal funding, and city residents’ needs are all changing.</p>
<p dir="ltr"><strong>What is HHC?</strong><br />HHC is a public-benefit corporation—similar to the MTA (Metropolitan Transportation Authority)—that runs the largest public hospital system in the United States. Consisting of 11 hospitals in four of New York City’s five boroughs, HHC treats around 1.4 million patients per year, according to its <a href="http://www.nyc.gov/html/hhc/downloads/pdf/publication/2014-hhc-report-to-the-community.pdf">2014 Report to the Community</a>. HHC also administers MetroPlus, a low-cost health insurance program open to New York City residents.</p>
<p dir="ltr">As a “safety-net” hospital whose stated goal is to provide healthcare “regardless of ability to pay,” around 80 percent of HHC patients are Medicare or Medicaid recipients, or uninsured. The system also serves the estimated 500,000 undocumented immigrants—of which 200,000 are undocumented and uninsured, <a href="http://www.undocumentedpatients.org/wp-content/uploads/2015/04/Undocumented-Immigrants-and-Access-to-Health-Care-NYC-Report-April-2015.pdf" target="_blank">according to</a> the New York Immigration Coalition—living in New York City.</p>
<p dir="ltr">Starting next year, HHC will also provide health services to inmates at city jails and prisons—a role Mayor Bill de Blasio assigned to the agency in June after a city <a href="http://www.nytimes.com/2015/06/11/nyregion/report-details-failings-of-corizon-rikers-island-health-provider.html?_r=0" target="_blank">investigation</a> revealed that contractor Corizon Health Inc. hired doctors with disciplinary problems and criminal convictions.</p>
<p dir="ltr">“De facto, it serves a lot of very vulnerable patients in New York, in very high volume,” said Andrea Cohen, senior vice president for program at the United Hospital Fund, a healthcare research and advocacy nonprofit. “What it does today is provide an essential safety net.”</p>
<p dir="ltr">At a November policy breakfast hosted by Citizens Budget Commission, HHC CEO Dr. Raju explained his general healthcare philosophy and the organizing principle behind HHC services. “I would argue,” he said, “you do have a stake in the good health of the cook preparing the meal in your favorite restaurant and the good health of your nanny, and the good health of your housekeeper. My health depends on that cook’s health, upon that maid’s health, upon your health.”</p>
<p dir="ltr">HHC was formed in 1969 to take over the city’s former Department of Hospitals. According to James Colgrove, a sociomedical sciences professor at Columbia, HHC was created partly in response to a perceived cost crisis earlier in the decade. With its own - albeit mayor-appointed - board of directors, HHC has “more bureaucratic flexibility and cost controls” than regular city agencies, Colgrove said. This means that HHC is more independant—both organizationally and financially—and less affected by changes in city policies and finances than typical city agencies.</p>
<p dir="ltr">The corporation’s <a href="http://council.nyc.gov/html/budget/2016/Pre/hhc.pdf" target="_blank">budget in fiscal year 2016</a>, which began July 1, is projected to be nearly $6.5 billion—of which only $215 million, or 3 percent, will come directly from the city. But with operational independence comes financial challenges--HHC projects an operating loss of more than $750 million in 2016, growing to $1.5 billion in 2019.</p>
<p dir="ltr"><strong>Ongoing and New Challenges</strong><br />According to HHC’s preliminary 2016 budget, the corporation’s past and projected deficits are due to years of New York State <a href="http://gothamgazette.com:8080/index.php/health/655-fights-over-medicaid-could-threaten-new-administrations-health" target="_blank">Medicaid cuts</a> combined with growing patient numbers. In 2014, more than 80 percent of HHC’s revenues were been from Medicaid- or Medicare-related fees. The remainder comes from non-Medicaid or Medicare fees and a variety of federal, state, and city grants.</p>
<p dir="ltr">President Barack Obama’s Affordable Care Act also includes reductions in Medicare and Disproportionate Share Hospital (DSH) funds—a form of supplemental Medicaid given to hospitals that serve large numbers of uninsured patients. The rationale behind these cuts is that with a smaller number of Americans uninsured, hospitals will not need as much federal funding—but that doesn’t mean HHC will benefit in the short-term. The corporation received $1.8 billion in DSH money in 2014—more than 27 percent of its intake that year—while it expects to only receive $1.2 billion by 2018.</p>
<p dir="ltr">HHC’s current financial situation isn’t new or surprising. That’s partly because it’s politically difficult to reorganize or close hospitals, institutions with large union staffs and high levels of community involvement. While running for mayor, de Blasio <a href="http://www.crainsnewyork.com/article/20140120/BLOGS04/140129989/de-blasio-vows-to-fight-hospital-closures" target="_blank">campaigned against</a> the planned closing of Long Island College Hospital in Brooklyn. Former Mayor Ed Koch’s decision to close HHC’s Sydenham Hospital in 1980, as part of an attempt to close a budget deficit, <a href="http://www1.cuny.edu/mu/forum/2015/03/10/mayor-ed-koch-calls-1980-sydenham-hospital-closing-a-mistake-in-latest-laguardia-and-wagner-archives-youtube-video/" target="_blank">sparked protests</a> across Harlem. “Concerns over cost are as old as hospitals themselves,” Colgrove said.</p>
<p dir="ltr">Debt-rating agency Fitch <a href="https://www.fitchratings.com/site/fitch-home/pressrelease?id=980011" target="_blank">affirmed</a> its ‘A-plus’ score on HHC bonds in February, saying HHC’s role as a safety-net provider positions it “well to secure sufficient levels of funding from city, state, and federal sources necessary to continue to operate and pay debt service.”</p>
<p dir="ltr"><strong>What lies ahead for HHC?</strong><br />Raju, appointed by de Blasio at the start of 2014, <a href="http://www.capitalnewyork.com/article/city-hall/2015/09/8577102/city-hospital-head-reorganize-hierarchy-emphasize-ambulatory-care" target="_blank">announced</a> in September plans to restructure HHC’s corporate hierarchy with the goal of ultimately expanding services and growing revenues. The plan came five months after Raju outlined his <a href="http://www.nyc.gov/html/hhc/html/news/press-release-20150407-dr-raju-public-address-way-forward-hhc-tomorrow.shtml" target="_blank">vision</a> for a financially stable HHC by 2020.</p>
<p dir="ltr">City Council members expressed concerns about HHC’s deficit during a <a href="http://www.capitalnewyork.com/article/city-hall/2015/05/8568498/council-alarmed-hhcs-15-b-deficit" target="_blank">budget hearing in May</a>. Watchdog group Citizens Budget Commission published a <a href="http://www.cbcny.org/sites/default/files/REPORT_HHC_11062014.pdf" target="_blank">report</a> last November describing the corporation’s “troubled” financial picture.</p>
<p dir="ltr">Raju’s plan is to replace HHC’s current structure of hospitals in a network with an organization based on lines of service. The new hierarchy will reduce bureaucracy and allow ambulatory and post-acute services to grow more quickly over the coming years, Raju <a href="http://capitalnewyork.com/article/city-hall/2015/09/8577102/city-hospital-head-reorganize-hierarchy-emphasize-ambulatory-care" target="_blank">told Politico New York</a> last month.</p>
<p dir="ltr">Cohen said Raju’s plan doesn’t pose immediate financial risks for HHC—but has a large upside potential should it succeed.</p>
<p dir="ltr">“[HHC] has had a deficit for a long time, but it has always found new ways to restructure,” Cohen said. “Dr. Raju’s strategy is growth, and it’s a very ambitious and positive strategy.” New payment models in healthcare, she added, “allow strategies which don’t just look at the cost side but caring for the full patient.”</p>
<p dir="ltr">Another part of Raju’s goal for 2020 is to expand HHC’s MetroPlus insurance membership to 1 million—an additional potential source of revenue. Although MetroPlus was the most popular plan on New York’s health insurance market in 2014 and more than 428,000 individuals were enrolled in 2015, that’s only a 7 percent increase compared to 2010.</p>
<p dir="ltr">“The whole system is really undergoing substantial transformation, and HHC has absolutely embraced it in a huge way, but it’s hard,” Cohen said. “There is execution risk, but they are ambitiously tackling it.”</p>
<p dir="ltr">***<br />by Christian Zhang, Gotham Gazette<br /><a href="https://twitter.com/GothamGazette" target="_blank">@GothamGazette</a></p>Amid Federal Brinksmanship, New York City Officials Redouble Support for Planned Parenthood2015-10-01T22:24:31+00:002015-10-01T22:24:31+00:00http://www.gothamgazette.com/?id=5917:amid-federal-brinksmanship-new-york-city-officials-redouble-support-for-planned-parenthoodSuper User<p dir="ltr"><img src="http://www.gothamgazette.com/images/Chirlane_PP.jpg" alt="Chirlane PP" width="600" height="400" /></p>
<p dir="ltr"><span style="font-size: 10pt;">NYC First Lady Chirlane McCray at a Planned Parenthood rally (photo: @Chirlane)&nbsp;</span></p>
<hr />
<p>In the face of federal debate and brinksmanship over funding for Planned Parenthood, many in New York City have doubled down on support for the women's health care organization.</p>
<p dir="ltr">In the past month, the city has seen the<a href="https://www.plannedparenthood.org/planned-parenthood-new-york-city/newsroom/press-releases/press-release-planned-parenthood-of-new-york-city-hosts-groundbreaking-for-new-queens-health-center" target="_blank"> opening</a> of a Planned Parenthood health center in Queens (expanding the organization's presence into all five boroughs), <a href="http://www.nystateofpolitics.com/2015/09/here-and-now-1368/" target="_blank">two</a> large rallies during which numerous elected officials championed the importance of Planned Parenthood’s health care services, and one leading Assembly Democrat<a href="http://observer.com/2015/09/albany-should-step-in-if-planned-parenthood-loses-federal-funding-assembly-dem-says/" target="_blank"> calling</a> for the state to boost its financial support for the clinics if conservatives in Congress were to cut off the organization's federal funding.</p>
<p dir="ltr">“The attacks against Planned Parenthood, we all know, are attacks against women and, in particular, low-income women and women of color who rely on Planned Parenthood for vital services - medical services that are comprehensive,” City Council Speaker Melissa Mark-Viverito said at a large rally in Manhattan Tuesday. The speaker and others rallied in support of Planned Parenthood, repeatedly attacking conservative Republicans for their efforts to defund the organization.</p>
<p dir="ltr">The city government’s strong support for Planned Parenthood, seen at Tuesday’s rally, which featured several elected officials, and in budget dollars that go toward supporting the organization, help cement New York City’s national reputation as a liberal capital.</p>
<p dir="ltr">On Wednesday, Congress avoided a government shutdown by<a href="http://www.nytimes.com/2015/10/01/us/politics/government-shutdown-congress.html?_r=0" target="_blank"> passing</a> a temporary spending bill that will keep federal agencies operating through December 11. The threat of a potential shutdown over funding of Planned Parenthood loomed for weeks, spurred by the release of secretly filmed videos this summer which showed Planned Parenthood officials casually discussing the preservation of fetal tissue for medical research.</p>
<p dir="ltr">The Center for Medical Progress, the anti-abortion group that filmed the videos, claims that they show Planned Parenthood officials discussing the illegal sale of aborted fetal tissue. The videos have prompted an ongoing investigation by Congress into Planned Parenthood’s practice of donating fetal tissue for medical research. A forensic analysis of the videos commissioned by Planned Parenthood found evidence of manipulation, "intentionally deceptive edits, missing footage, and inaccurately transcribed conversations," according to<a href="http://www.politico.com/story/2015/08/planned-parenthood-undercover-videos-report-finds-manipulation-121800" target="_blank"> Politico</a>, which obtained a copy of the report.</p>
<p dir="ltr">Four states - Alabama, Arkansas, Louisiana, and Utah - have ordered state agencies to cut off federal funding to local Planned Parenthood chapters, leading those branches to file lawsuits. According to the <a href="http://bigstory.ap.org/article/6d148d6b083946f18b28e211a6296535/planned-parenthood-sues-utah-after-it-cuts-federal-money" target="_blank">Associated Press</a>, in court documents, the Utah branch said the governor's decision to cut off funding is based solely on unproven allegations that took place in other states, by other arms of the national group.</p>
<p dir="ltr">New York City government sends approximately $850,000 a year to the city’s central Planned Parenthood branch in the forms of various grants, namely for health care services and sex education, according to an official from PPNYC. The city also allocates capital awards to Planned Parenthood each year, which have ranged from $75,000 to $400,000.</p>
<p dir="ltr">Speaking about the services that Planned Parenthood provides for New York City residents, PPNYC CEO Joan Malin told Gotham Gazette, “Roughly 85 percent of our services are preventative care - birth control, cancer screenings, HIV testing, STI testing, annual exams - we do the full range of reproductive health care services for women and men.”</p>
<p dir="ltr">Malin explained that Planned Parenthood New York’s funding comes from a combination of “private donors, public funding from the city, state, and federal government,” and an endowment, “but for our patient services, we rely overwhelmingly on Medicaid and Title X family-planning grants, which allows us to provide services for anyone who needs our care regardless of their ability to pay. Out of a $44 million budget, $9 million is federal funding. If that were to go away we would be sorely challenged to continue to provide our services."</p>
<p dir="ltr">Mark-Viverito, joined on stage at Tuesday’s “Pink Out NYC” rally by fellow Council Members Helen Rosenthal and Brad Lander, said, "We are proud as Council members to ensure that we direct your taxpayer dollars and invest your taxpayer dollars in Planned Parenthood, to make sure that they are able to provide vital services throughout the City of New York. We expect the federal government to continue to do the same thing."</p>
<p dir="ltr">The rally on Tuesday in lower Manhattan was one of nearly 300 events held in<a href="http://www.newsweek.com/planned-parenthood-pink-out-day-377904" target="_blank"> 90 cities</a> across the country in support of Planned Parenthood’s work, organized as negotiations continued in Washington, D.C.</p>
<p dir="ltr">"Congress should be ashamed!" New York City First Lady Chirlane McCray shouted to the crowd of some 500 pink-clad supporters, just hours before it was announced that government funding would be extended until mid-December. "Congress should be ashamed to punish women who have no other health care options. I know firsthand that Planned Parenthood provides excellent services!"</p>
<p dir="ltr">McCray continued, “Planned Parenthood provides services to "2.7 million women, men, and young people....Did you realize that? We need Planned Parenthood and we will not allow the funding to be taken away!"</p>
<p dir="ltr">McCray, Mark-Viverito, Rosenthal, and Lander were joined at the rally by Public Advocate Letitia James, Comptroller Scott Stringer, and state Senators Daniel Squadron and Liz Krueger.</p>
<p dir="ltr">"Our bodies will not be used as an organizing strategy for the right," Public Advocate James shouted, eliciting cheers from the crowd. "This is nothing more than a distraction from the issues that we care about — a need to educate girls, a need to end income inequality, and a need to end poverty in this country."</p>
<p dir="ltr">James pointed out that the bulk of services Planned Parenthood provides have nothing to do with abortion, despite the national conversation being focused on the abortion issue. "Let me tell you the facts,” James said, “80 percent of Planned Parenthood clients receive services to prevent unintended pregnancies. Planned Parenthood provides nearly 400,000 pap smears, and 500,000 breast exams every year. These tests detect life-threatening cancers. Planned Parenthood provides nearly 4.5 million tests and treatments for sexually transmitted infections and diseases, and Planned Parenthood educates and provides outreach to 1.5 million young people."</p>
<p dir="ltr">On Thursday, Council Member Laurie Cumbo, who chairs the Council’s Committee on Women’s Issues, emailed Gotham Gazette to call Planned Parenthood of New York City a long-time “staunch advocate, educator, and provider of reproductive health care to 50,000 patients annually.” PPNYC “has received funding from the New York City Council to expand services to support family planning, curb teen pregnancy and STDs through education.”</p>
<p dir="ltr">When asked what might happen next for Planned Parenthood, even with a temporary compromise in Washington, PPNYC CEO Malin replied, "This issue is going to remain in the public discussion, unfortunately. As all of our speakers said, there are so many issues that we need to be talking about - greater access to health care, immigrant reform, Black Lives Matter - there's so many issues we need to be talking about. Focusing on reproductive health care is important, but the way [opponents are] talking about it is a distraction. I would say that that distraction is going to continue throughout this election, and Republicans are going to look for ways to keep this issue at the forefront."</p>
<p dir="ltr">Not all Republicans are looking to keep the issue of defunding Planned Parenthood in the spotlight, however. Republican strategist and president of Somm Consulting, Evan Siegfried, told Gotham Gazette, “Until we know what the facts are, the calls to defund are premature.”</p>
<p dir="ltr">Congressional investigation is ongoing, and as analysis of the incendiary videos showed the footage had been drastically altered, Planned Parenthood Federation of America CEO Cecile Richards testified before Congress just this Tuesday. Richards defended the $450 million in federal funding that goes to Planned Parenthood, explaining that 87 percent of it comes from Medicaid and Title X family planning monies. “We, like other Medicaid providers, we are reimbursed directly for services provided,” she said.</p>
<p dir="ltr">“No federal funds pay for abortion services, except in the very limited circumstances allowed by law. These are when the woman has been raped, has been the victim of incest, or when her life is endangered,” Richards explained (abortions account for just three percent of Planned Parenthood’s services nationally, according to the organization’s most recent <a href="http://issuu.com/actionfund/docs/annual_report_final_proof_12.16.14_/0" target="_blank">report</a>).</p>
<p dir="ltr">Hard-line conservatives like Texas Senator and Republican presidential candidate Ted Cruz are committed to defunding Planned Parenthood to the point that they would rather<a href="http://www.huffingtonpost.com/entry/ted-cruz-government-shutdown-planned-parenthood_55dcd12de4b08cd3359db3af" target="_blank"> plot</a> to shut down the government than allow the organization to continue its work through federal funding.</p>
<p dir="ltr">Cruz recently <a href="https://twitter.com/teddyschleifer/status/648700538423517184" target="_blank">decried</a> the state of his divided party, saying that the more socially liberal Republicans, specifically the “New York billionaire” donors who insist candidates are pro-choice, hate the base and hold the party back from really fighting on key social issues. It’s part of the intra-Republican conflict that led to House Speaker John Boehner’s recent resignation announcement.</p>
<p dir="ltr">Speaking anonymously with Gotham Gazette, New York Republicans have indeed expressed frustration with the far right wing of their party, with one saying it is “on a crazy quest that will kill [Republicans] with the swing voters in 2016.”</p>
<p dir="ltr">***<br />by Meg O'Connor, Gotham Gazette<br /><a href="https://twitter.com/megoconnor13" target="_blank">@MegOConnor13</a><br /><a href="https://twitter.com/GothamGazette" target="_blank">@GothamGazette</a></p><p dir="ltr"><img src="http://www.gothamgazette.com/images/Chirlane_PP.jpg" alt="Chirlane PP" width="600" height="400" /></p>
<p dir="ltr"><span style="font-size: 10pt;">NYC First Lady Chirlane McCray at a Planned Parenthood rally (photo: @Chirlane)&nbsp;</span></p>
<hr />
<p>In the face of federal debate and brinksmanship over funding for Planned Parenthood, many in New York City have doubled down on support for the women's health care organization.</p>
<p dir="ltr">In the past month, the city has seen the<a href="https://www.plannedparenthood.org/planned-parenthood-new-york-city/newsroom/press-releases/press-release-planned-parenthood-of-new-york-city-hosts-groundbreaking-for-new-queens-health-center" target="_blank"> opening</a> of a Planned Parenthood health center in Queens (expanding the organization's presence into all five boroughs), <a href="http://www.nystateofpolitics.com/2015/09/here-and-now-1368/" target="_blank">two</a> large rallies during which numerous elected officials championed the importance of Planned Parenthood’s health care services, and one leading Assembly Democrat<a href="http://observer.com/2015/09/albany-should-step-in-if-planned-parenthood-loses-federal-funding-assembly-dem-says/" target="_blank"> calling</a> for the state to boost its financial support for the clinics if conservatives in Congress were to cut off the organization's federal funding.</p>
<p dir="ltr">“The attacks against Planned Parenthood, we all know, are attacks against women and, in particular, low-income women and women of color who rely on Planned Parenthood for vital services - medical services that are comprehensive,” City Council Speaker Melissa Mark-Viverito said at a large rally in Manhattan Tuesday. The speaker and others rallied in support of Planned Parenthood, repeatedly attacking conservative Republicans for their efforts to defund the organization.</p>
<p dir="ltr">The city government’s strong support for Planned Parenthood, seen at Tuesday’s rally, which featured several elected officials, and in budget dollars that go toward supporting the organization, help cement New York City’s national reputation as a liberal capital.</p>
<p dir="ltr">On Wednesday, Congress avoided a government shutdown by<a href="http://www.nytimes.com/2015/10/01/us/politics/government-shutdown-congress.html?_r=0" target="_blank"> passing</a> a temporary spending bill that will keep federal agencies operating through December 11. The threat of a potential shutdown over funding of Planned Parenthood loomed for weeks, spurred by the release of secretly filmed videos this summer which showed Planned Parenthood officials casually discussing the preservation of fetal tissue for medical research.</p>
<p dir="ltr">The Center for Medical Progress, the anti-abortion group that filmed the videos, claims that they show Planned Parenthood officials discussing the illegal sale of aborted fetal tissue. The videos have prompted an ongoing investigation by Congress into Planned Parenthood’s practice of donating fetal tissue for medical research. A forensic analysis of the videos commissioned by Planned Parenthood found evidence of manipulation, "intentionally deceptive edits, missing footage, and inaccurately transcribed conversations," according to<a href="http://www.politico.com/story/2015/08/planned-parenthood-undercover-videos-report-finds-manipulation-121800" target="_blank"> Politico</a>, which obtained a copy of the report.</p>
<p dir="ltr">Four states - Alabama, Arkansas, Louisiana, and Utah - have ordered state agencies to cut off federal funding to local Planned Parenthood chapters, leading those branches to file lawsuits. According to the <a href="http://bigstory.ap.org/article/6d148d6b083946f18b28e211a6296535/planned-parenthood-sues-utah-after-it-cuts-federal-money" target="_blank">Associated Press</a>, in court documents, the Utah branch said the governor's decision to cut off funding is based solely on unproven allegations that took place in other states, by other arms of the national group.</p>
<p dir="ltr">New York City government sends approximately $850,000 a year to the city’s central Planned Parenthood branch in the forms of various grants, namely for health care services and sex education, according to an official from PPNYC. The city also allocates capital awards to Planned Parenthood each year, which have ranged from $75,000 to $400,000.</p>
<p dir="ltr">Speaking about the services that Planned Parenthood provides for New York City residents, PPNYC CEO Joan Malin told Gotham Gazette, “Roughly 85 percent of our services are preventative care - birth control, cancer screenings, HIV testing, STI testing, annual exams - we do the full range of reproductive health care services for women and men.”</p>
<p dir="ltr">Malin explained that Planned Parenthood New York’s funding comes from a combination of “private donors, public funding from the city, state, and federal government,” and an endowment, “but for our patient services, we rely overwhelmingly on Medicaid and Title X family-planning grants, which allows us to provide services for anyone who needs our care regardless of their ability to pay. Out of a $44 million budget, $9 million is federal funding. If that were to go away we would be sorely challenged to continue to provide our services."</p>
<p dir="ltr">Mark-Viverito, joined on stage at Tuesday’s “Pink Out NYC” rally by fellow Council Members Helen Rosenthal and Brad Lander, said, "We are proud as Council members to ensure that we direct your taxpayer dollars and invest your taxpayer dollars in Planned Parenthood, to make sure that they are able to provide vital services throughout the City of New York. We expect the federal government to continue to do the same thing."</p>
<p dir="ltr">The rally on Tuesday in lower Manhattan was one of nearly 300 events held in<a href="http://www.newsweek.com/planned-parenthood-pink-out-day-377904" target="_blank"> 90 cities</a> across the country in support of Planned Parenthood’s work, organized as negotiations continued in Washington, D.C.</p>
<p dir="ltr">"Congress should be ashamed!" New York City First Lady Chirlane McCray shouted to the crowd of some 500 pink-clad supporters, just hours before it was announced that government funding would be extended until mid-December. "Congress should be ashamed to punish women who have no other health care options. I know firsthand that Planned Parenthood provides excellent services!"</p>
<p dir="ltr">McCray continued, “Planned Parenthood provides services to "2.7 million women, men, and young people....Did you realize that? We need Planned Parenthood and we will not allow the funding to be taken away!"</p>
<p dir="ltr">McCray, Mark-Viverito, Rosenthal, and Lander were joined at the rally by Public Advocate Letitia James, Comptroller Scott Stringer, and state Senators Daniel Squadron and Liz Krueger.</p>
<p dir="ltr">"Our bodies will not be used as an organizing strategy for the right," Public Advocate James shouted, eliciting cheers from the crowd. "This is nothing more than a distraction from the issues that we care about — a need to educate girls, a need to end income inequality, and a need to end poverty in this country."</p>
<p dir="ltr">James pointed out that the bulk of services Planned Parenthood provides have nothing to do with abortion, despite the national conversation being focused on the abortion issue. "Let me tell you the facts,” James said, “80 percent of Planned Parenthood clients receive services to prevent unintended pregnancies. Planned Parenthood provides nearly 400,000 pap smears, and 500,000 breast exams every year. These tests detect life-threatening cancers. Planned Parenthood provides nearly 4.5 million tests and treatments for sexually transmitted infections and diseases, and Planned Parenthood educates and provides outreach to 1.5 million young people."</p>
<p dir="ltr">On Thursday, Council Member Laurie Cumbo, who chairs the Council’s Committee on Women’s Issues, emailed Gotham Gazette to call Planned Parenthood of New York City a long-time “staunch advocate, educator, and provider of reproductive health care to 50,000 patients annually.” PPNYC “has received funding from the New York City Council to expand services to support family planning, curb teen pregnancy and STDs through education.”</p>
<p dir="ltr">When asked what might happen next for Planned Parenthood, even with a temporary compromise in Washington, PPNYC CEO Malin replied, "This issue is going to remain in the public discussion, unfortunately. As all of our speakers said, there are so many issues that we need to be talking about - greater access to health care, immigrant reform, Black Lives Matter - there's so many issues we need to be talking about. Focusing on reproductive health care is important, but the way [opponents are] talking about it is a distraction. I would say that that distraction is going to continue throughout this election, and Republicans are going to look for ways to keep this issue at the forefront."</p>
<p dir="ltr">Not all Republicans are looking to keep the issue of defunding Planned Parenthood in the spotlight, however. Republican strategist and president of Somm Consulting, Evan Siegfried, told Gotham Gazette, “Until we know what the facts are, the calls to defund are premature.”</p>
<p dir="ltr">Congressional investigation is ongoing, and as analysis of the incendiary videos showed the footage had been drastically altered, Planned Parenthood Federation of America CEO Cecile Richards testified before Congress just this Tuesday. Richards defended the $450 million in federal funding that goes to Planned Parenthood, explaining that 87 percent of it comes from Medicaid and Title X family planning monies. “We, like other Medicaid providers, we are reimbursed directly for services provided,” she said.</p>
<p dir="ltr">“No federal funds pay for abortion services, except in the very limited circumstances allowed by law. These are when the woman has been raped, has been the victim of incest, or when her life is endangered,” Richards explained (abortions account for just three percent of Planned Parenthood’s services nationally, according to the organization’s most recent <a href="http://issuu.com/actionfund/docs/annual_report_final_proof_12.16.14_/0" target="_blank">report</a>).</p>
<p dir="ltr">Hard-line conservatives like Texas Senator and Republican presidential candidate Ted Cruz are committed to defunding Planned Parenthood to the point that they would rather<a href="http://www.huffingtonpost.com/entry/ted-cruz-government-shutdown-planned-parenthood_55dcd12de4b08cd3359db3af" target="_blank"> plot</a> to shut down the government than allow the organization to continue its work through federal funding.</p>
<p dir="ltr">Cruz recently <a href="https://twitter.com/teddyschleifer/status/648700538423517184" target="_blank">decried</a> the state of his divided party, saying that the more socially liberal Republicans, specifically the “New York billionaire” donors who insist candidates are pro-choice, hate the base and hold the party back from really fighting on key social issues. It’s part of the intra-Republican conflict that led to House Speaker John Boehner’s recent resignation announcement.</p>
<p dir="ltr">Speaking anonymously with Gotham Gazette, New York Republicans have indeed expressed frustration with the far right wing of their party, with one saying it is “on a crazy quest that will kill [Republicans] with the swing voters in 2016.”</p>
<p dir="ltr">***<br />by Meg O'Connor, Gotham Gazette<br /><a href="https://twitter.com/megoconnor13" target="_blank">@MegOConnor13</a><br /><a href="https://twitter.com/GothamGazette" target="_blank">@GothamGazette</a></p>